It’s nice to see some reporting on the potential causes of the issues folks are facing with filling Adderall prescriptions.
I’ll provide an anecdotal observation…
My SO has narcolepsy and uses Adderall to, quite literally, function. It’s unfortunate that this malady wasn’t referenced in the article but considering it affects (and I’m guessing here) less than 5% of the population, it makes sense. However (and I can appreciate the concern of individuals who suffer from ADHD), an individual who is suffering from narcolepsy and cannot access their medication can result in what could be argued as a zombie like state.
I can, somewhat, appreciate the impetus behind the idea of putting up blockers to prevent the access of recreational drugs. But, as a former opioid addict, I also have found that limiting legitimate access (when a drug maker isn’t influencing the FDA to make up addictive tiers) typically results in a greater crime than what was initially attempted to prevent.
Suffice to say, without getting too political, pick a representative that has more than a hammer when they’re viewing a nail.
There’s always methamphetamine, dextroamphetamine and brand names for different amphetamines or drugs like methylphenidate and armodafinil, and then of course the specialty name drugs.
If you ever have trouble accessing adderall, be sure to know that modafinil specifically treats narcolepsy and is easier to get both with and without a prescription.
I have idiopathic hypersomnia and Modafinil/Nuvigil worked great for a while, but then it very much didn’t agree with me in ways that are hard to express. I’ve seen others with the same issue online.
They annoying part is I’d love to have a prescription again to see if it works well for me again, or to take breaks from my stimulants - but my doctor says it’ll trigger an audit as I have both Vyvanse and Adderall prescriptions. What exactly that means I don’t know but he doesn’t seem keen.
Articles like this and reading about the FDA forcing drug manufacturers to replace pseudoephedrine (effective cold medicine) with phenylephrine (basically a placebo) really make me wonder about the intelligence level of the federal agencies.
The restrictions on pseudoephedrine were mandated by Congress through the Combat Methamphetamine Epidemic Act of 2005 (passed as part of the patriot act) which followed various state legislatures’ passages of similar laws.
The main driving force behind the law was Bush’s White House drug task force and several members of Congress.
Federal agencies very, very, rarely solicit or propose legislation like this. And Congress rarely asks for their input.
It was added as a part of a reauthorization of the original Patriot Act.
US Federal policy making and legislation is a bit like calvinball. And for misc reasons, Congress tends to pass large (omnibus) bills, instead of more reasonable units of work.
As an outsider looking in, I collect and read stuff about "the sausage factory".
Here's one study that looks past the folk theories, to illuminate how some example laws came to be. Similarly comprehensive books could be written about most all major legislation.
"The Schoolhouse Rock! cartoon version of the conventional legislative process is dead, if it was ever an accurate description in the first place. Major policy today is often the product of “unorthodox lawmaking” and “unorthodox rulemaking”—deviations from traditional process marked by frequent use of omnibus bills and multiple agency implementation; emergency statutes and regulations issued without prior comment; outsourcing to lawmaking commissions and unconventional delegates; process shortcuts outside of emergencies; presidential policymaking; and outside drafters, some nonpartisan and others hyperpartisan. These unorthodoxies are everywhere, and they have shifted the balance in the elected branches and beyond, often centralizing power in actors—like party leadership and the White House—not traditionally part of the core lawmaking and rulemaking processes. These unorthodoxies are the new textbook process."
BOOK: Unorthodox Lawmaking: New Legislative Processes in the U.S. Congress [2017]
Did the FDA force drug manufacturers to replace pseudoephedrine with phenylephrine or did Congress make it more difficult to purchase pseudoephedrine and drug companies decided to make new products with phenylephrine to sell in addition to pseudoephedrine products?
Pharma companies decided to sell a drug that doesn’t work so they wouldn’t lose sales from pseudoephedrine going behind the counter. They could have simply chosen not to, alas. Also, that switch was required by law. It wasn’t at FDA’s discretion.
Results matter. I don't care if you're doing a bad job because you're evil or because you're stupid or because you're staffed with a bunch of people who are mostly apathetic and the few who aren't and are driving policy are tunnel vision extremists with mission goals that do not line up well with the public (a frequent situation for these kinds of organizations). Stop doing a bad job.
Correct. It's sometimes referred to as "mission blindness": when a bureaucracy (or part of a bureaucracy) is so focused on short-term mission goals to the detriment of everything else. The people taking these actions will continue this path unless the told otherwise.
Again, this presupposes that they are prioritizing things in some objective way. Perhaps based on the data they're looking at, it makes sense to do this. And no, "they should ignore that data because it's obviously wrong, according to me" isn't valid.
I've never had a problem getting pseudoephedrine, though it is behind the counter in a pharmacy these days. There are limits, but they are well over what I would consider a therapeutic dose. I don't know if that varies state-to-state, but I doubt it's a federal issue.
Pharmacists and pharmacy techs are given "training" on how to identify supposed fraudulent sales. e.g. if your hair is long or you otherwise look like a person who would manufacturer amphetamines (whatever that looks like) they won't sell it to you.
So, congrats to you for looking like a fine upstanding person and not like a clandestine drugs manufacturer.
> Pharmacists and pharmacy techs are given "training" on how to identify supposed fraudulent sales. e.g. if your hair is long or you otherwise look like a person who would manufacturer amphetamines
I am sorry, what? Maybe I have just been lucky my entire life, but that has never been my experience. I used to have long hair for many years, and I haven't had a clean-shaven face in years. Dark circles under my eyes is a common thing. I also have ear piercings, and I dress in baggy non-assuming casual clothing most of the time. Not once was I ever questioned about or refused any behind the counter drugs at any of the pharmacies I've been to across multiple states. They do ask for an ID to purchase those behind the counter drugs, but I am pretty sure they are legally obligated to do it for everyone, due to the regulations that the thread is talking about.
Also, I believe you meant to say "methamphetamines". There is no illegal amphetamine manufacturing epidemic (and I am not aware of there ever being one), but there was a methamphetamine one.
Anyone can by pseudoephedrine, but there’s a system that checks to make sure you haven’t exceeded your monthly limit, and if someone is talking about meth or makes a joke about meth while buying pseudoephedrine, it might raise a red flag, but generally pharmacies sell it to anyone since there’s really no workaround the the monthly limits.
perhaps it's different in your state, but in mine you can only get one box/month regardless of how much is in the box. and the size of the boxes available varies. if you manage to get a 96-count box then that's enough for once/day of the regular dose (2 tabs/day) plus some extra. but 96 is often sold out across many local pharmacies (I'd guess about half the time I try), and then the next best option is 48. this means you don't have enough for once/day (I need 2 tabs once/day as prescribed by my doc). sometimes all that's available is 24-count. or none at all. add to this that the state verification system goes down with some frequency, and on those days nobody can buy at all (and you don't know until they have your box within arms reach and you're trying to pay). so every month I end up on a hunt for this medication that is extremely frustrating and sometimes doesn't result in me getting what I need. meanwhile meth rages anyway--while domestic production went down after the sudafed restrictions, consumption continues due to illegal imports.
This outrage-bait is curiously at odds with the sentiment in the sibling post by /u/fnordfnordfnord. Do you want front-level employees to judge whether somebody "look like a person who would manufacturer amphetamines" or not? If the answer is yes, then people who look sketchy in some random pharmacy worker's opinion are the only ones to get arrested, whether or not they're actually up to anything. If the answer is no, then yes indeed it's correct to arrest grandmas who break the law because we're not allowed to judge whether they look like they're cooking meth or not.
Personally, no, I don't really want front-level employees refusing to sell sinus medication on a whim. It doesn't really work for alcohol (i.e. it doesn't stop kids from getting alcohol, but does create headaches for adults). Alcohol is, in aggregate, probably more destructive to society.
But it's also wrong to arrest grandmothers on drug charges and send them through the system for a violation of some legislator's arbitrary limit. Turns out it didn't solve the meth problem, but it did make the world a little worse to live in.
Also, I think describing the article as "outrage-bait" is in poor taste for this site. A different implication might be that when criminal charges are tied to an action with the intent of limiting an activity, those charges will inevitably be applied to "the wrong people" (maybe you?) for a different activity, and that we should be skeptical of problem-solving-through-force.
Remember last time we had a nationwide Adderall shortage it was deliberately caused by Shire to force people onto Vyvanse.
Prior to Vyvanse Shire has signed a generic supplier agreement with TEVA so generic adderall was just the brand drug stamped differently. When they had Vyvanse ready they cancelled the agreement on short notice. That sent TEVA scrambling to stand up a production line.
Standing up a C2 line is a pain because of the DEA approvals and quotas. The quotas also prevent any of the other generic makers from ramping up their own production. The quota setting process is retrospective and by design it can't respond quickly to market changes like this.
So keep an eye out on who has a new patented medication for ADHD coming out and follow the money trail. The big drug companies love to turn a crisis into an opportunity and it wouldn't be surprised if they lobbied to include non-opioids in the settlement to give them cover for this sort of manipulation.
> Sometimes, they must send patients on frustrating journeys to find pharmacies that haven’t yet exceeded their caps in order to buy prescribed medicines.
Does this then get them put on the secret list of "people with drug seeking behaviors" which apparently includes people who fill prescriptions for their dogs? [0]
It is absolutely insane right now with medication... My wife blew out her knee last year, breaking her tibia, patella and femur. Do you know how many painkillers they gave her to take home? 12 pills! They said to come back to the ER to get more if she needed them, before surgery the following week(?!). I think it was like a 3 day supply and we both were like WTF.
My 1 year old dog (who is batshit insane, but we still love her) had to have part of her tail amputated because she kept breaking it open, the vet had us giving her 3x painkillers 2x a day. The pharmacy tech insisted they weren't going to fill a followup script because she had already been prescribed 60 pills, 10 days before and refused to perform basic math. (3*2*10=60)
I'm all for trying to address our opioid issues, but it feels like instead of addressing the issue of doctors running pill mills, over-prescribing these drugs, they are focused on just not allowing them to be prescribed at all... Even for people who genuinely need them.
I think there's two schools of thought on this one.
A: Time limited access to narcotics is safe and effective pain management for severe but temporary injuries and I don't exist to suffer in this world -- give me the good stuff.
B: If I can reduce my pain into "bearable" with nsiad painkillers then I don't want to take narcotics.
I think one of the dangers of B in the real world is that for severe pain doctors are terrified of prescribing narcotics that they put you on the nsaid cycle with extremely high doses which can wreck your stomach lining and liver.
When I was recovering from surgery they gave me Xanax, Vallium and Tylenol to basically sedate me for 2 straight weeks because of this nonsense and it was miserable. Just trading one kind of high for another but the new way you mostly keep the pain.
I’m not trying to say that narcotic painkillers are ineffective or necessarily dangerous.
I am saying that many kinds of pain can be managed with OTC medication. There aren’t necessarily two schools of thought. It’s more that if let’s say ibuprofen isn’t helping the pain, it may just be that you aren’t taking enough of it. It is a very effective pain medicine.
What a shitty take. There’s only so much ibuprofen you can take before the risks start outweighing the benefits, and there’s plenty of pain that is much stronger than that.
Actually you can take quite a bit of ibuprofen for a short period of time with no long term problems. You can also take ibuprofen and acetaminophen. It is quite the hot take that narcotic pain meds are safer.
I’m not at all suggesting ibuprofen for pain management of cancer patients or people immediately after major surgery.
But for a big chunk of outpatient procedures enough OTC pain meds will actually work just fine.
I’m not some granola advocate here. Nor am I trying to say that everyone should just tough it out. But you can’t seriously say that 800mg ibuprofen is more dangerous or less effective than opioids for wisdom teeth removal
Have you suffered excruciating pain for multiple days in a row? Non stop? Like so bad that your muscles recoil in horror that then causes even more pain in a recursive loop of horror?
Actually yes, in Germany if you break your bones you get ibuprofen, if you get your wisdom teeth pulled, you get ibuprofen.
We don't have an opioid crisis anymore.
Pain is a fact of life. The problem in the US is that there's the expectation to work the next day. It's ok to be in pain, it's also ok to miss out on work.
If you accept these two basic facts you don't have an opioid crisis anymore.
I see you have never been in any real pain, ever. What do you get for cancer in Germany? Still ibuprofen?
There's a reason opioids exist and were such a revolution in medicine. They really work. Ibuprofen et al are fine for what they are, but anti-inflammatories can only do so much. We should be able to solve the over-prescribing and addiction issues as a society without throwing the baby out with the bathwater.
"I've had some back pain and got prescribed opiates, now i'm addicted"
We're not talking about getting some opiates after surgery or severe and mostly rare things. Americans get opiates for all kinds of small inconveniences, like a wisdom tooth removal, or some back pain. Opiates don't heal or fix back pains. They just mask the symptoms and create a new problem.
I've been in a lot of pain in my life and never took any opiates, because they are reserved for extreme situations where i live. In america, i would have had easy access to prescriptions for those in most cases.
I’ve had opiates for wisdom tooth extraction and a couple of relatively minor but very painful injuries. I was very glad to have them. They made the experiences much more bearable. I did not experience any addiction issues, and I’m glad that my access to these medications was not limited due to some people’s inability to handle them.
I really don’t think forcing needless suffering on everyone is the answer to this problem.
Opiates for wisdom teeth extraction are entirely unnecessary.
Source: had six very painful teeth extractions, with bone grafts and two sinus repairs. I was almost pain-free on 600mg ibuprofen + 600mg acetaminophen every 6 or so hours. I say "almost" because I was not dumb enough to try any type of exercise, or eating crunchy cereal, but I had no problem falling and staying asleep or going back to work in 24 hours.
So I am not entirely sure why you think opiates were necessary or provided you the type of relief that OTC meds could not provide. My double-board-certified, extremely expensive dental surgeon doesn't seem to think so.
I also had abdominal surgery, for which I can concur opiates do help quite a bit, which is entirely separate story.
Who is suggesting ibuprofen for cancer? Come on now. There is absolutely time and place for narcotic pain killers. But there are a lot of doctors prescribing them for really minor things. Few years ago I got vicodin after a root canal. It was baffling
>I see you have never been in any real pain, ever. What do you get for cancer in Germany? Still ibuprofen?
I guess not. My point still stands though. Americans in Germany whine all the time about not getting "proper" pain medication. It's an attitude problem.
I have been in pain multiple times, mostly broken bones, wisdom teeth, tendons and the like, and in the moment it doesn't feel good to only get ibuprofen.
But most pain is not too much to take and it's ok for you to feel it. It's better than getting an addiction problem for life.
As you say it's an over-prescribing issue. Keep opioids only for extreme pain. Not for normal pain.
I would much prefer to be given more than ibuprofen for surgery, thanks. Have you have had tumor removed from your body? That would hurt like the dickens with just some tylenol and no real pain meds or anesthesia.
> If you accept these two basic facts you don't have an opioid crisis anymore.
This is an incredibly simplistic view of a very complex issue.
Why is it so hard to understand? I don’t think anyone here is saying there is no legitimate use for narcotic pain killers. If anyone is in huge amount of pain, by all means, take what you need. However it should almost never be default first line pain management outside of the hospital.
You what?
Did you really just say “other people may die but that is a price I’m willing to pay”? Like you’re in charge of who dies and who lives or something
Oh I absolutely agree with him. The opioid crisis is tragic but denying people medication for their injuries, illnesses, mental health (adhd) in a completely ineffective attempt to curb a crisis that is mainly caused by the importation of cheap fentanyl analogs is the greater of two evils.
Breaking a bone doesn’t perpetually hurt like a Charlie horse that never stops tightening. Gout for example in the big toe can be the most painful experience ever, speaking as someone who’s been in many accidents. It can last several days, it feels like a shark biting your toe off every second.
Actually in the US you also get ibuprofen.
I had very invasive jaw surgery and sinus repair. It hurt. I got 600mg ibuprofen and 600mg acetaminophen for the pain every 4-6 hours. It definitively took pain down to tolerable levels.
as a counterexample, I had an infected tooth over the weekend. I took ibuprofen and acetaminophen around the clock, and it did jack shit. I was lying in bed and whimpering in pain, so close to going to the ER, but I knew they wouldn't do anything for me.
I actually have mild PTSD about that incident. It was the second-worst pain I've experienced in my life, and it wouldn't stop.
After the pharmacies got sued for filling opiate prescriptions (which were written by abusive doctors, but the pharmacies are the ones who got sued)[1], is it any surprise that Xanax and Adderall are being limited? If pharmacies are at risk for filling prescriptions that are more complex than antibiotics, the end result is that they make it harder to fill them.
> is it any surprise that Xanax and Adderall are being limited?
That depends on who is doing the limiting — if the pharmacy corporations are self-limiting then I would understand they are limiting their potential exposure/liability to whatever risk level they are comfortable with. I’ll still be able to find my necessary drugs at another chain which doesn’t limit.
If the government is doing the limiting, then yes, that would be surprising. That seems to be the case here, and I think it’s a very inappropriate response — totally attacks the wrong part of the system.
The article goes to lengths to describe how the government, specifically the DEA are limiting supply by issuing edicts to pharmaceutical companies. Corporations don't generally defy government edicts, especially ones that lead to raids and jail time, so we really can say it's the government's doing here, rather than particularly self-limiting behavior on the part of the pharmaceutical companies.
That the government is threatening defiance of edicts with fines and jail time and not using direct means to stop additional production is not a distinction worth making - the government is limiting the supply of these medications.
Can you please provide a cite? I tend to think this coercion probably is happening.
Agency rule making should be public and published in federal register. I don't know what the effective recourse would be. The easy track is to go to Mexico and load up on what your Dr. prescribed.
I agree should be, but unfortunately that's not the case. Not in proper detail. Broadly, the DEA's power comes from the Controlled Substances Act, originally passed in 1970 - https://en.wikipedia.org/wiki/Controlled_Substances_Act, but the modern day limits themselves are secret.
The medications described are Schedule II, which is defined as "The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions."
> Xanax and Adderall Access Is Being Blocked by Secret Drug Limits
> The Drug Enforcement Administration regulates the manufacturing, distribution and sale of controlled substances, which can be dangerous when used improperly
> the limits themselves are secret.
> A Cardinal Health document reviewed by Bloomberg News says that limits are calculated on a daily, monthly, and quarterly basis.
Someone willng to pursue a lawsuit might file a FOIA and pursue in court for non-response. A sketchy approach could be suing pharmacy for ... something ... then find the limits for that company via legal discovery.
Land of the free or not.
We might be able to get the ACLU to sign on. They've filed a number of lawsuits for patients being denied gender-affirming care in various states. Without getting into a debate about the politics of gender-affirming care, those lawsuits would seem to spell out that denial of life-affirming care that sufferers of ADHD, a federally recognized disability, have experienced could give them legal standing to sue doctors over.
> those lawsuits would seem to spell out that denial of life-affirming care that sufferers of ADHD, a federally recognized disability, have experienced could give them legal standing to sue doctors over.
As a person with adhd, why would i want to sue my provider? They have nothing to do with why there's been an adderall shortage since october. it seems to me the last thing I want to do is make providers feel averse to treating adhd out of concern for being sued.
Not a lawyer, but it seems plausible that doctors here do 'nothing' in terms of doing damages that would establish legal standing. A doctor that is prescribing medications indicated to treat a diagnosed condition at reasonable dosages isn't doing harm/inflicting damages on patients. And if there are broader social harms coming from aggregated practices of physicians in general (e.g. over-prescribing), it would be unreasonable for any individual physician or medical practice to bear the burden of punishment/compensatory payment on behalf of the industry in general.
This sort of thing is better handled through regulatory and legislative means. Perhaps it's not being handled particularly well at the moment, but the status quo seems preferable to establishing precedent that one can successfully sue a doctor for writing appropriate prescriptions for drugs that are scarce due to supply chain bottlenecks.
as per the article, the limits are being imposed by the DEA not the pharmacies and not the distributors.... a better approach would be to do a FOIA on the DEA and get all evidence about their restrictions on distributors for schedule IV narcotics (xanax, adderall, etc) and then sue the DEA maybe for interfering with interstae commerce, i dont know...
In my brooklyn neighborhood, our pharmacist is basically the neighborhood “doctor”. He’s so trustworthy and conscientious that neighbors typically check with him before going to urgent care or making a real doctor appointment for anything. Then if he doesn’t see you for a couple of days he calls to make sure you’re feeling better. It’s all very cute and the relationships and position of trust reminds of what I imagine small town family medicine practice is like.
They can and should—that’s their area of expertise. I’ve had pharmacists catch dangerous but obscure drug interactions that my doctors failed to catch, typically because the two interacting medications were prescribed by two different types of doctors. Even though both would’ve had access to the same medical records and my full medication list, and even though that data was being checked by a computer, mistakes happen and databases are sometimes incomplete.
I've had pharmacists deny me because I was paying for amphetamine without insurance. They said it was suspicious and refused to call my doctor to confirm that I wasn't some sort of criminal.
That's the kind of unreasonable power that they shouldn't have. Finding bad drug combos? I don't think anyone has an issue with that.
If you find a customer to be suspicious (I was wearing a black t-shirt, to be fair), you should be required to call the customer's doctor office and confirm the prescription.
> That's the kind of unreasonable power that they shouldn't have.
Then the government should come out and say they will not go after pharmacists for filling any and all prescriptions.
The government wants it both ways, keep doctors and pharmacists liable and randomly nail, but not clearly publish standards of rules so no one can accuse the government of intervening in people’s right to healthcare.
Government gets plausible deniability and someone to throw under the bus. No reason for the people that can get thrown under the bus to stick their neck out.
Even if you do everything right they're still often suspicious. I suspect pharmacies keep tabs of "suspicious activity" like asking for an early refill before a work trip.
These secretive DEA limits just underline a weird "moral judgment" of people who have conditions that benefit from stimulant medications. Almost like its our faults for having neurochemistry's that don't uphold the perceptions of a protestant work ethic.
The worse part is that its mostly separated from any particular religion nowadays but agencies like the DEA that essentially self-reinforce this lopsided moral code.
I concur, pharmacists have no legal basis nor license basis in determining the decision making of a licensed medical doctor. The doctor is the one that provided the care came up with the diagnosis and came up with the plan for the prescription for the medication. The only role the pharmacist has is in dispensing that medication. it's wholly inappropriate for a pharmacist to get into the business of second guessing the work of a licensed MD.
For one thing, pharmacists aren’t just retailers. For example, I take a very powerful medication. It’s essential to get the dose just right.
My health care organization employs a pharmacist who sepecializes in the medication, and sets the doses for patients in the program.
This pharmacist doesn’t dispense medication. She instructs the physicians on what dose to prescribe.
I recently had an extremely painful medical event. I was given hydrocodone, but it didn’t have any effect. A pharmacist was called in, and they figured out a drug cocktail that addresses the pain.
Pharmacists really are medical experts and a knowledgeable part of the care team. Doctors should use their expertise more than they do. And it’s completely appropriate for a pharmacist to assertively demand an explanation for what’s going on.
as mentioned throughout the comments I've also seen many situations where patients that were given prescriptions were then turned away by pharmacists because they didn't like the type of clothes that the person was wearing or they didn't think that there was a diagnosis to match the prescription, or that the doctor was too far away in a different town in the same state, Even though the patient might have been taking this medication for 20 years or more... This is only happening recently within the last few years, specifically after the multibillion dollar settlement by CVS and Walgreens that happened in November of 2022... so I'm not buying it that pharmacists are allowed to Trump the decision making of medical doctors.
I guess you are right, according to some articles online [1], a pharmacist can refuse to dispense a prescription due "moral and/or religious" reasons.... so they literally can just look at you and say well you know what I don't think you deserve this stuff sorry go somewhere else and I guess it's perfectly okay, because of a moral duty, which is vague and specious.
And that is such b.s. the one and only time I seeked medication for a certain issue, even though I went through a lot of embarassing process to get a perscription I was questioned like I was a drug dealer or something by the pharmacist in front of many people standing there.
Short of life and death situations I don't think I will be seeking any kind of medical care in the US. If it isn't urgent I'll make a vacation out of it and travel to cheaper more humane countries.
>which were written by abusive doctors, but the pharmacies are the ones who got sued
Must be nice to have a professional organization that acts like a cartel and makes lesser people pay for the sins of all but the worst of the worst actors.
It’s amusing watching the hn commentariat freak out that they can’t get their amphetamine after years of telling chronic pain sufferers to just tough it out because opiates and the Sacklers are bad.
I need adderall to function but on my last refill the pharmacy was out and when I asked when they’ll get more the tech said “maybe next year?”. I got my doc to switch me to vyvanse which is 3x the price even with good insurance since it’s still brand only. I don’t like vyvanse compared to plain generic adderall but I’ll take what I can get.
Seems like they’d make dispensing it harder rather than just cut off the supply to everyone.
Personally, while I don't take either now, I could never go back on Vyvanse due to the severe appetite suppression I experienced on that medication which I did not have with Adderall. These medications are not completely interchangeable.
Completely agree, for me Vyvanse lasts longer than two-dose adderall IR and XR, which affects my sleep and appetite a lot. Basically the release is more spread out, so it’s less effective when its at its peak, even though the actual metabolized d-amp is higher than I was at formerly with IR. It’s also a lot more expensive for me. I hate it, but it’s all I can get.
The wonderful medical experts at the DEA have my gratitude for coming up with such an excellent solution to the scourge of telehealth. I’m sure they did a thorough analysis weighing disrupting/ending millions of stable ADHD patients’ treatment against the possibility of someone getting medication they might not need.
How much they vary seems to be very patient specific (perhaps amplified or muted by their relative dosages? ie Vyvanse max of 70 is supposed to be comparable to Adderall max of 60). I personally experience just the same appetite suppression with both (severe, although if I actually put a bite of food in my face it can sometimes “break the spell”). But I know other people notice the difference more like you do. They’re definitely not interchangeable, but how much so might vary from deal breaker as it is for you, to basically indistinguishable as it is for me (at least on the appetite suppressant topic).
Not meant to argue, I just don’t want to unnecessarily dissuade people who might be having trouble filling Adderall and weighing the possibility of temporarily substituting so they have something to fill the gap.
Vyvanse is AKA lisdexamphetamine which is a slow release form of dexamphetamine AKA dexadrine. The Astral Codex guy says patients prefer dexadrine and patient reports suggest it lacks some of the body affects.
All to say maybe try the cheaper dexadrine twice a day.
Dexedrine is also facing supply issues. Really all stimulants are but it seems to affect IR medications (and XR adderall) the most, likely because adderall IR was the first be impacted and then patients switched to other IR medications or the XR version.
Good, body effects should not be present in ADHD medication.
I like Vyvanse because it does not affect my heart or blood pressure. It's like coffee for the brain without the jitters. And since it takes hours to peak, there is never a come up feeling one might associate with it and derive pleasure from. I take it, and eventually after a couple hours I find I am well awake and present more than any coffee, yet still feeling very calm and at ease.
That said, I take the lowest effective amount (20+20mg) which requires good sleep and good diet to be effective. So it never turns me into a productive robot, and I have to accept that some days are a bit lower-energy.
Not medical advice but IIRC, Vyvanse is essentially the name-brand product with an extra methyl group stuck on. Your pancreas produces an enzyme called Trypsin that breaks off that methyl group, and turns it into the active ingredient. It's considered an extended release because the enzyme's availability is limited in your body.
Trypsin is not exactly a common supplement, but you might consider looking into which kinds of foods can inhibit or encourage its production. Grains and cereals will probably inhibit it, unfortunately.
Lisdexamfetamine is the right-handed dextroamphetamine with an L-Lysine amino acid attached to the nitrogen atom. Regular adderall is a mix of the left and right handed enantiomers of amphetamine.
I had long suspected I had ADHD. After covid, my brain became wrecked. I wanted to go with something non-addictive due to my checkered past. Easily would recommend, as long as you don't have terribly low blood pressure.
NAD.
Another thing to try is NAD+/CoQ10 supplements. I had some brain fog after covid (I'm officially diagnosed) and NAD+ seemed to help a ton.
I had researched the brain fog with covid 19 and found a lot of research pointing to NAD+ / mitochondrial disruptions as source of brain fatigue [eg 1]. NAD+ supplements are well studied for anti-aging too. So it seemed to have a high probability of helping.
The NAD+ supplements can increase it according to a few research articles I've found. IIRC, it's like 10-20% increase in some cases. I also added CoQ10 as it works together with NAD+.
I currently have to drive 45-60 minutes one way to get to a pharmacy in a small town to get my adderall filled. I’m in downtown Seattle and it’s the closest option. I assume my pharmacy only has it because it’s mostly an older retirement community and they likely don’t have many adderall users.
It’s massively fucking annoying to take nearly three hours out of my day to pick up my meds. And it’s massively fucking annoying to have to worry about losing a critical medication every month and sometimes also having to spend literally half a day calling around to find a place that has it in stock.
If it helps, and if you/your doctor are willing to make a temporary switch, I haven’t had trouble getting Vyvanse filled in Seattle. It’s not exactly the same but may be a close enough substitution. It is more expensive but if you can afford that, it might be worth the peace of mind.
IMO Vyvanse is better than Adderall except for being more expensive.
I was on Adderall XR 20mg for 10 years and then switched to Vyvanse 50mg. For me, Vyvanse lasts longer, doesn't have as much of a narcotic peak, and feels like it's more consistently strong for the whole curve.
Just putting it out there because some people have suggested that it was an inferior alternative (and it may be for some people). Some people definitely prefer Vyvanse.
As usual, start with half a pill on these kinds of drugs. Mix it into water so you can easily drink 50% of it one day, 75% of it another day depending on how you feel.
- Vyvanse 50 is roughly twice the dosage of Adderall 20
- It’s generally not a good idea to split the XR pills, but they won’t split the same way. As I understand it: Adderall XR and its generics are typically designed as a dual release (either two immediate doses, one delayed; or one immediate and one gradual; both can have the peak/drop off effect). Vyvanse has a more continuous release because its release mechanism depends on digestive enzymes to convert the chemical itself. (If I’ve got any of this wrong, my apologies, but I do think it’s appropriate to caution about splitting the XR pills unless you understand what that entails. Ideally this is a conversation with your doctor, not randos on the internet)
I’m on mobile so I can’t easily skim websites for more official sources, but you can definitely find my conversion in the wild, like on http://www.adhdmedcalc.com/ — I didn’t make it up.
One annoying thing about stimulants is that your first day taking it is a lot different than your 15th day in a row. I always end up ramping up until there’s some equilibrium with tolerance, else day 1 is way too strong, or day 15 is too weak.
I definitely didn’t think you made it up. And yeah that site does match 20 Adderall XR to 50, which is very odd because it also says 20 of the other Adderall is too high for a Vyvanse equivalent. For Adderall XR it also lists a maximum dosage of 30, which is not true. I think they’re treating the XR as two doses, and halving to accommodate that? That is definitely not how I’ve ever had it discussed or prescribed by my doctor, or fulled by a pharmacy. And it’s inconsistent with Vyvanse which is also XR and always treated as a single dose.
In any case if you were taking Adderall XR “20” and it was actually two doses (40) that would be equivalent to the Vyvanse.
I very much don’t find the equivalent doses of Vyvanse and Adderall…uh, equivalent. I don’t know if it has to do with the delivery mechanism or the norepinephrine component but personally I feel like ~35mg of Adderall is closer to Vyvanse’s 50mg.
I have idiopathic hypersomnia and not ADHD, though.
You can get more exotic prescription stims still from most places. E.g. Mydayis (adderall xr with three instead of two sets of granules), Azstarys (methylphenidate and a prodrug methylphenidate), and Adzenys (different type of slow release adderall). If they call any Bartells they will tell them what they have in stock. Have them do that before contacting the doc, then have them tell the doc what is available.
I don't understand why pharmacies are the target. People that want Xanax and Adderall for recreational use start with doctor shopping for doctors that will write prescriptions for more than needed, for people that don't need it, etc. So, I could sort of understand identifying doctors that write a disproportionate number of prescriptions for these, or a high ratio of prescriptions for high doses versus more common doses. But the pharmacies? Why? What does that accomplish? Doesn't the person just then go to a different pharmacy?
I find it fascinating how so many HN users ardently defend broad access to Adderall (which has tons of possible downsides, but also tons of positive use cases), but then claim that any and all uses of any and all opiates will lead to a deadly, incurable addiction, even though opiates also have tons of positive use cases too.
Won't find that opinion from me. I take Adderall after having been denied it (by my mom) as a teenager and it basically turned my life around. If people have surgery and need opiates, as long as it's controlled and monitored like both meds should be then have at it. I don't want anyone to suffer.
They don't. You can find many of the same feedback in this thread, and lots of people are defending the dangerous under prescription of Adderall, which I consider a civil rights violation.
Here's a clue: compare the income and SES of opiate addicts vs Adderall addicts. Which socioeconomic group is the average Hackernews more likely to fall into?
Thanks for reminding me which medication[1] I forgot to take... again.
My ADHD[3] must've made me very addicted to Adderall, huh.
Perhaps consider that people with ADHD tend to thrive in creative professions, especially if they allow an opportunity to hyperfocus (the disorder is named awfully[2]), have somewhat flexible schedules, and excel in emergencies / high stress situations.
That's to stay, there's a correlation between people in tech (especially the startup scene) and ADHD people who benefit greatly from stimulants.
So here's a clue: people like you using phrases like Adderall addicts only perpetuates the stigma, and leads to the current situation with hidden limits and other shady bigotry.
Consider clicking the links below, and learning more about what ADHD is, and why and how medication helps people who have it. This is my personal experience, written up specifically for this purpose.
I don't count people with ADHD taking Adderall as prescribed as Adderall addicts, the same way I don't count people who are on prescription morphine to manage pain, and are careful about their usage, opiate addicts.
The fact is that people use ADHD medications recreationally, or off-label to increase their focus e.g. in preparation for exams, in knowledge work, etc. And those people are at high risk of developing addiction.
ADHD patient here. If one did not have ADHD I could see someone possibly becoming dependent, as well as unintentional weight loss.
Personally I forget to take it often, but thats because my brain is wonked out with ADHD. I also forget to eat often if I do not take the medication. Life is certainly weird.
I guess it is time to send an FOIA request to the DEA to find out what the limits are.
I'm on a controlled substance and I am disabled and not able to work without it. I've been extremely lucky thus far, but given how many I know have had issues, it is only a matter of time.
It’s potentially life threatening. Similar to alcohol withdrawal. So similar, as I understand it, that benzos are sometimes used in hospitals as a substitute for alcohol weening in severe withdrawal cases.
I've wondered if Adderall could be popular in part because it can lead to weight loss. This wouldn't be why people would go on the medication, but why they would hesitate going off it. I know some people continued smoking after they wanted to stop because they feared gaining weight when they did.
In my experience ADHD medicine doesn't actually induce weight loss, despite weight loss being a desirable thing for me.
It suppresses your appetite, sure, but it doesn't shield you from the effects of not eating all day. I often force myself to eat something for lunch or I'll just end up tired and annoyed in the afternoon/evening (edit: I don't eat breakfast).
Plus, once the medicine wears off at night (or on weekends when I skip taking it), I usually get ravenously hungry and easily make up any caloric deficit.
Yeah, when I was on dextroamp, it would completely eliminate my appetite. I'd have to eat breakfast before taking it, and at about 8-10pm when it wore off, I was STARVING, and would eat everything in the fridge. At actual dinner time, I would stare at a delicious plate of food and not even feel like touching it despite not having eaten since 7am.
Adderall is not (usually) prescribed for weight loss, it would be an off-label use as well. There are stimulant medications like adderall that are prescribed and work much better at appetite reduction than Adderall.
Adderall is prescribed for weight loss, according my my psychiatrist, but it’s not approved to treat weight loss. Although similar drugs like vyvanse are approved for binge eating disorder. I think adderall is prescribed when patients can’t afford vyvanse. Although vyvanse is going generic this year.
Yeah, I added the second sentence to clarify. I'm sure people don't go on it primarily to lose weight, but I could see how it would become a one-way ratchet if going off it causes weight gain.
Perhaps for non-ADHD people. There's a common meme on ADHD channels about forgetting to take it and how hard it is to remember to take it daily. Some days you just don't want to take it and straightjacket your brain.
For me getting off a regular dosage just caused a bit of extra sleepiness for a week or two. I drank like 2 redbulls a day for a bit. There is a bit of addictiveness because its nice to be able to function like normal people day to day -- like paying bills on time because your brain has enough dopamine for a boring chore.
Its nothing nearly as addictive or habit forming as SSRI's that are given out like candy.
>Its nothing nearly as addictive or habit forming as SSRI's that are given out like candy.
SSRIs aren't considered addictive at all.
As I mentioned to someone else, please take an earnest visit to https://www.reddit.com/r/StopSpeeding/ and consider the idea that a lot of our ADHD peers struggle with stimulants.
>Perhaps for non-ADHD people.
I've been diagnosed with ADHD twice (childhood and adult) and I can say from experience that speed gets everyone high. That's a myth. Take a double dose of your prescription and report back whether you feel it (sort of kidding, it's a dangerous path).
Stimulant addiction is certainly real, but addiction recovery groups are obviously going to self-select for people that have/had a problem. The reality is that there are millions of people who take ADHD medicine at therapeutic doses (which should _not_ induce a high, FWIW) for years without developing an addiction or needing dose increases.
Knowing the potential risks of stimulants is good, but unduly scaring people or over-restricting access for the majority who use them properly is not helpful.
>Stimulant addiction is certainly real, but addiction recovery groups are obviously going to self-select for people that have/had a problem.
Please re-read how I presented that link carefully. I've encountered several people here claiming that stimulants don't get you high and that they aren't addictive. The point of sending them to that sub was to demonstrate that others have a different experience. I'm not making a larger argument here that they are harmful for everyone, just that they aren't magic drugs and they might have glowy feelings about them for a less comfortable reason than they think.
People downvoting me for stating simple known facts about these drugs is troubling...
> I've encountered several people here claiming that stimulants don't get you high and that they aren't addictive.
Just because stimulants _can_ get you high and be addictive doesn't mean they will when taken appropriately. The only time I felt any kind of high from my ADHD medicine was the first day I took it. And I quite easily skip taking it on weekends, with the only side effect being that I browse the internet all day and struggle to do anything productive.
To be honest, I don't actually like being on stimulants. Methylphenidate made me feel like I was constantly in low-grade fight-or-flight mode and dextroamphetamine (which I'm on now) gives me mild emotional blunting. Plus both cause slight dry mouth, appetite suppression that I have to forcibly eat through, and insomnia if I take them too late in the day. Not to mention the fundamental hassle of taking pills every day within narrow bands of time, something I regularly procrastinate and/or forget. (Also, I have tried taking higher/double doses as you suggested earlier when I was figuring out my optimal dose. They just made me feel jittery and on edge - not exactly pleasant.)
If I had no ambitions or responsibilities, I would be more than happy to throw my medicine away and sit around on my computer all day every day. Unfortunately, I do have ambitions and responsibilities and medication helps mitigate my crippling, career-threatening inability to get things done. So I'll take that tradeoff.
>Just because stimulants _can_ get you high and be addictive doesn't mean they will when taken appropriately.
I'm definitely calling out inappropriate usage, so I don't disagree.
>Plus both cause slight dry mouth, appetite suppression that I have to forcibly eat through, and insomnia if I take them too late in the day. Not to mention the fundamental hassle of taking pills every day within narrow bands of time, something I regularly procrastinate and/or forget.
Yeah the side-effects are not great. Throw in teeth-grinding, compulsive behaviors, irritability, aggressiveness, etc.
>If I had no ambitions or responsibilities, I would be more than happy to throw my medicine away and sit around on my computer all day every day. Unfortunately, I do have ambitions and responsibilities and medication helps mitigate my crippling, career-threatening inability to get things done. So I'll take that tradeoff.
I'm happy to hear about your self control. I wish I were effective as a person naturally, I'm sure you can relate. Unfortunately they don't work for me as well as they once did.
Actually, my self control is really quite bad. I'm terrible at doing difficult or unpleasant things and am very prone to low-effort, self-destructive hedonism. But as a result I have a very intense fear of addiction because I know I would struggle to pull myself back from it - I've never drank alcohol or done any recreational drugs for that exact reason. I was very hesitant about pursuing potentially lifelong medication, I requested the smallest possible starting dose from my doctor, and I don't intend to ever increase it beyond what I currently take (10mg/day).
On a philosophical level I still don't _like_ that I'm taking medication, but the benefits are significant enough that I tolerate it. And perhaps ironically, ADHD medicine actually helps me push past my lazy hedonism and do things that are necessary but dull.
(I would note that it doesn't make me _want_ to do boring things, nor do I think it's supposed to if dosed correctly. Even on medication, I'd still rather play video games than do work. But it at least makes it possible for me to sit down and work anyway. Whereas before, every day was an exercise in staring futilely at the screen while begging my brain to do literally anything.)
> I wish I were effective as a person naturally, I'm sure you can relate.
Very much so. I really wish my productivity wasn't dependent on medicine that
a) I need to remember to even take
b) Has annoying negative side effects
c) Is a controlled substance, with all the hassle that brings
But unfortunately, I guess that wasn't meant to be.
There’s really no link between your average person taking 5–10 mg of Adderall twice a day and a support group for people smoking upwards of a gram of meth a day.
Please be more careful and honest in your assertions. My point is that there are people who struggle with abusing prescription stimulants. I did not make a comparison or suggest a link between harder stims like your strawman suggests.
A 200lb person can get a decent high from as little as 30mg of adderall.
You should know better than suggesting your anecdote is enough to prove a myth either way. Stimulants aren't magical medications that affect all ADHD people radically differently than neurotypicals. You are just experiencing a very common phenomena where drugs impact some people differently.
>You are just experiencing a very common phenomena where drugs impact some people differently.
Yes, I am experiencing a very common phenomena where drugs impact the people with the condition the drug is prescribed for differently than those without it.
I'm a person with diagnosed ADHD and I know a lot of people with ADHD and none of us experience that with stimulants. You're generalizing that all ADHD people experience the opposite effect, so I don't find your argument credible.
These drugs were not designed and created for ADHD. They were discovered separately. They alleviate some of the symptoms of ADHD, but it doesn't suddenly make you act and think like a neurotypical. You act and think like an ADHD person on speed. Also, a lot of people who take them have very positive and unrealistic beliefs about them because they are high on the drug.
And thats BS. It's completely physically and psychologically addictive for many people with severe withdrawal symptoms. If they're not considered addictive then thats an issue with the DSM and inconsistent metrics used by medical fields.
> As I mentioned to someone else, please take an earnest visit to https://www.reddit.com/r/StopSpeeding/ and consider the idea that a lot of our ADHD peers struggle with stimulants.
I'm sure many do struggle with abusing stimulants. They're not silver bullets, and do need appropriate care and monitoring by a medical professional. Especially when starting a new treatment.
However, I find that link is also full of things like "Bob was addicted to Adderal, and took 30mg everyday for 8 years". To me thats sounds like a successful therapeutic treatment without other supporting info like "Bob would use his monthly supply in a week". Few would consider "Bob took a normal dosage of an SSRI for 8 years" as an addiction.
> That's a myth. Take a double dose of your prescription and report back whether you feel it (sort of kidding, it's a dangerous path).
To clarify, I'm sure some do get a mild high. Many don't. Maybe I'd get one on a higher dose, but I've got no desire to do so as I get much more enjoyment over just feeling awake and being able to focus. Though I definitely get a "mild high" if I accidentally take an extra dose of my SSRI.
I disagree with you about the SSRIs based on my (basic) research in general, but given you said it has that effect on you personally I accept that as a data point.
>However, I find that link is also full of things like "Bob was addicted to Adderal, and took 30mg everyday for 8 years". To me thats sounds like a successful therapeutic treatment without other supporting info like "Bob would use his monthly supply in a week". Few would consider "Bob took a normal dosage of an SSRI for 8 years" as an addiction.
Of course there are a mix of experiences described there. If someone decides they have a problem with a drug and are struggling to stop, can we decide if it's not true? I doubt it. I don't think people are LARPing as stim addicts, but also I'm sure there are some people who struggle more than others.
>To clarify, I'm sure some do get a mild high. Many don't. Maybe I'd get one on a higher dose, but I've got no desire to do so as I get much more enjoyment over just feeling awake and being able to focus. Though I definitely get a "mild high" if I accidentally take an extra dose of my SSRI.
I'm glad you are able to keep them in a healthy place in your life. Thanks for sharing your experiences.
I'm in the same boat, though, its only been about 7 years for me. It feels like with all these artificial shortages, it isn't even worth trying to find a doc to prescribe me something, I just won't be able to get it or if I do, I won't be able to keep getting it.
Every other prescription I've had has an adult (anti-acids, urinary meds, SSRI, buproprion) was eventually cut off from refills because I didn't do the followup appointments. At least I can get OTC pepcid these days, I lost a lot of weight and don't need as much.
Best to just continuing wallowing in unemployment.
It can be rough out in the unmedicated jungle. The peer pressure is fairly intense these days. I am in a similar boat - Complete abstinence of these kinds of things is the only option for me.
Atomoxetine and modafinil are other options in this space and aren't (usually) dependency forming. It's worth exploring your options if things are bad because doctors are more open to alternatives nowadays.
I’ve been diagnosed three times. At ages 6 , 18, and 23. Taking every drug. Adderall, vyvance, strattera, etc.
The diagnosing is hogwash. There isn’t a scientific test. All ‘psychiatrists’ do is take you in for a visit or two, listen to your story, and write you the prescription.
I used to be ‘unable to focus’, and took pills for it. I even see people addicted to them to the point they take sleeping medication and other pills to make up for those side effects. No thanks!
These are intense drugs, and not the good kind like DMT, LSD, or Marijuana. Which those, actually had a profound effect on me and my way of thinking. For example, weed makes me productive - and makes otherwise shit work - amazing.
Another thing is eating healthy, organic foods, vegetables, and pasture raised meats, along with exercise. These do wonders for your state of mind. Organic foods (and pasture raised meats, eggs, dairy) have up to 200x the nutrient levels compared to non-organic.
Lastly, self discipline. I had to learn to master my mind and truly discipline myself for my actions. And to make the effort to constantly ‘make it happen’, no matter what. It’s a set of values instilled and the courage to back up your own values when no one else is to judge you but your own mind. Don’t let you mind off the hook for so many things - “oh I didn’t make the bed…it’s fine” no, it’s not fine.
> All ‘psychiatrists’ do is take you in for a visit or two
Also, you know, multiple years of intense study.
Does eating well and exercise matter? Of course. I feel way better when I'm in the gym regularly. It does not in any way fix the problem with my brain chemistry, though - medication does.
You do you, but don't shit on people who've finally found a way to be normal.
one thing that is not mentioned in the article, is that for states with mandatory eprescription , this is now an absolute nightmare.
Patients are forced to call the overwhelmed PCP , to get a new RX to be sent to a new pharmacy, while the patient is busy with life/work....in the hopes that patient meds will be found at the new location when the RX finally arrives to the pharmacy. And then patient must repeat the dance in 30 days!
To anyone struggling to fill an Adderall script, look into Adzenys. It's literally the exact same drug, with a different release mechanism (orally disintegrating tablet instead of a capsule you swallow). It's also not nearly at the same demand level, so it's easy to fill.
Good. I understand that this makes life harder for people with actual ADHD, but it's clear now that abuse of Adderall, Vyvance, and other amphetamines as cognitive performance enhancer is rampant, and not just in software, but in academia, and other parts of society. No one should have to compete with these crypto methheads for jobs or PhD slots.
ADHD is supposed to be a disability, yet the post suggests it makes you a better programmer! Of course, if ADHD requires symptom-blunting medication, then is the post arguing that only un- or partially-medicated ADHD patients make better programmers? Or that fully-medicated ADHD patients, with some residual ADHD symptoms, make better programmers? Please. The post reads like amphetamine abusers trying to convince each other (and potential employers) that they're the best at what they do, despite not being able to do it without drugs.
Would you say the same about autism? It’s amazing we’ve found an effective treatment for ADHD. Why is it good that patients are often unable to access it? Who benefits?
I never said people with ADHD shouldn't receive treatment; I said there are far too many people who don't have ADHD popping amphetamines to get an edge in work or academia, and I'm glad to see they're finally being cut off from their dealers. For some reason, HNers really hate being told that not everyone taking these drugs 100% has ADHD and 100% needs them. Scott Aaronson's post on this (which was discussed here) is illustrative: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
> I didn’t realize how much of a psychiatrist’s time was spent gatekeeping Adderall.
"an edge in work"
Anecdata: anyone I've ever seen without ADHD who takes amphetamines for an "edge" does shit work. Period. Sure, they may do a lot of it, but it's complete and utter shit in quality.
Just to be clear, you’re agreeing with the author that it’s primarily a moral distinction? Since the shortage is impacting all patients equally it seems harsh to support it.
It would help to understand why you feel that it’s immoral; my interpretation is that you are saying it gives people an advantage at a cost that you don’t want to be forced into paying yourself in order to compete.
> It would help to understand why you feel that it’s immoral; my interpretation is that you are saying it gives people an advantage at a cost that you don’t want to be forced into paying yourself in order to compete.
It's not just moral; do you think there are no externalities to an ever-widening culture of rampant amphetamine abuse?
If you have trouble getting Xanax or Adderall through legal means, do not resort to buying them illegally from a dealer. These pills are often counterfeit and laced with fentanyl, or its analogues, with the intention of converting more people to opioids.
Honestly, I understand why they’d be limiting Xanax, but limiting Adderall is a little over the top. Xanax is probably the most dangerous drug in a pharmacy besides opioids, but Adderall is harmless compared to Benzos and opioids.
This seems just a little bit of a conspiracy theory but, giving it credence I would say that it might be because the drugs are ridiculously overprescribed. Particularly for those who just don't need it. In the case of ADD, once there was a medication for it the diagnosis took off like a rocket. Sort of like oxycodone..
Isn't that to be expected, though? There's plenty of people who wouldn't subject themselves to the ordeal of going to the doctors to pursue a diagnosis of an untreatable disease. You just suffer through it. In contrast, if there's a known treatment for it, then the reward (not having ADD symptoms) dramatically outweighs the cost (of drudging through doctors appointments).
I'd bet the number of surgeries significantly increased after we discovered anesthesia and sanitation. Not because more people were needing it, but because the outcomes were suddenly much better.
I suppose, but anecdotally I was told I have ADD by my family physician and was prescribed various stimulants including adderall and ritalin. I only stopped and got on a patch based medication when I was losing weight because of the amphetamines destroying my appetite and I was already a skinny bastard. The only difference I felt on the medication is that I was methed up. This could have been a misdiagnosis but the tests I was given that led to my diagnosis were frankly bullshit. Looking back it seemed incredibly easy and 'hand wavy' for the doc to just shut up the parent and schools and write up a prescription to 'solve the problem'. In my eyes, the only problem I had is that I thought school was a meaningless chore. Should we make children take meth because they don't like the system they're in?
> Should we make children take meth because they don't like the system they're in?
The flip side of this is that being unable to thrive in the system they're in is effectively dooming them to a substandard, more difficult life. If you think the system is broken, fix it, but ripping off the bandage before you have any sutures on hand is the opposite of a solution.
If I had started on medication younger, I undoubtedly would have done better in high school. If I had done better in high school, I would have gone to a better college, better college, better job etc. On the flip side, had I not gotten medicated in college, I very well could have flunked out.
So, yeah, it's a fucked up that the system doesn't accommodate for people slightly outside neurotypical-ness, requiring stimulant use to thrive, just like it's fucked up that it doesn't accommodate deaf people, making cochlear implants an extremely valuable treatment. But so long as that system is in place, restricting access to harm mitigation from that system because the system is fucked is unquestionably wrong.
The biggest flaw in this line of reasoning is that these drugs aren't inherently calming or causing docility. They are pretty powerful stimulants!
It's quite obvious when a troublesome kid has been misdiagnosed: they act as you would expect a child on stimulants to act. The behavior changes are mostly only useful if the child does have adhd. A non-adhd problem child on amphetamines is a powerful source of chaos.
> Amphetamines and methamphetamine are closely related.
In the field of biochemistry, this is virtually meaningless. A single substitution group is capable of producing wild changes in pharmacokinetics. The left and right-handed enantiomers of these molecules don't even act the same way in the body, and these aren't even positional isomers. The similarities with AMP and MAMP begin and end with being TAAR1 agonists. Off the top of my head, MAMP is also a potent agonist for sigma 1 & 2 receptors, and is generally more promiscuous.
Methamphetamine is a substituted amphetamine, not a "derivative". They're both simple substituted phenylethylamines, another TAAR1 agonist that is extremely prolific in your neurochemistry as we speak, and an incredibly diverse family of monoamines that range from lethal neurotoxin to serotonergic hallucinogen. The difference between the two is often as simple as a single atom moved 2 or 3 substitution points over. When you lack basic domain knowledge, please don't call other people dumb as you try (and fail) to correct them.
Methamphetamine is not a substitution for amphetamine. A substitution refers to the replacement of one atom or group of atoms in a molecule with another atom or group of atoms. A derivative, on the other hand, refers to a molecule that is derived from another molecule by modifying its molecular structure. In the case of amphetamine and methamphetamine, methamphetamine is derived from amphetamine by adding a methyl group (-CH3) to the amphetamine molecule, which modifies its molecular structure.
Amphetamines and methamphetamine are closely related drugs, as methamphetamine is a type of amphetamine. They both work in a similar way by increasing the release and blocking the reuptake of certain neurotransmitters, such as dopamine, norepinephrine, and serotonin, in the brain. As a result, they both have similar effect.
All you're doing is microdosing a terrible drug and calling it treatment. Addicts defend this, not logical healthy people.
> Methamphetamine is not a substitution for amphetamine.
I did not say it was a "substitution" which means something entirely different in this context, I said it was a substituted amphetamine. The rest of this comment reads like boilerplate drivel that completely ignores everything I actually wrote.
Methamphetamine is a schedule 2 drug and prescribed in the US, though significantly more rarely than amphetamine. Is there a difference between oral consumption of amphetamine and methamphetamine dosed out in correct proportion to the salts in question? Maybe, but certainly not that "big" of a difference.
The difference is one of chemistry, not law. A helpful analogy is to find another pair of drugs that people are more familiar with where the difference is a single methyl group: caffeine and theobromine (the stimulant in chocolate).
Saying that appropriately dosed amphetamine and methamphetamine don't have a "big" difference is like saying appropriately dosed chocolate and coffee don't have a "big" difference. The difference is clearly massive.
I disagree. In oral usage, when you control for potency, particularly with regard to the stereoisomer composition, amphetamine and methamphetamine are FAR closer in effect (and "side effects") than historically people have claimed.
Pointing to the methyl group is completely missing the point; I am not talking about the absolute chemistry, but the pharmacology.
It's a pretty huge difference. Desoxyn's focus improvement comes with a full-body euphoric rush, which while fun and all, dramatically increases its abuse potential and addictiveness. Amphetamine, in contrast, is just makes it easier to focus. Properly dosed, there's no rush, no euphoria, just slanted walls on the sides of your train of thought.
That's quite the mischaracterization. Stimulants even at low doses increase the dopamine in the brain and lead to a mild high. I don't think I've ever heard anyone ever call Adderall "boring" before either. That's like calling alcohol boring, maybe someone may not like the experience, but they both have immediate and noticeable effects and it's not just "I love studying" either.
Even Scott's article has examples of this, here's a story of a little girl becoming very high from a prescription stimulant:
"A spontaneous report from the manufacturer of Strattera (atomoxetine) described a 7-year-old girl who received 18 mg daily of atomoxetine for the treatment of ADHD. Within hours of taking the first dose, the patient started talking nonstop and stated that she was happy. The next morning the child was still elated."
Why are you conflating Adderall with all or any stimulants? Might as well throw in caffeine and sugar as things that "even at low doses increase the dopamine in the brain and lead to a mild high".
Not disagreeing with you wrt atomexetine but really should compare apples to apples.
You're right. I wasn't as careful as I could be, my intention was to cover common ADHD stimulants: adderall, ritalin, vyvanse, etc. Basically any of them that gives you a quick boost of dopamine and are addictive. I'm not a smart psychopharmacology guy, just have a lot of experience with stimulants. Perhaps ask for clarification instead of throwing out 'conflating' next time though?
Adderall is an amphetamine. It's a hard drug. And methamphetamine are closely related. Taking small doses of this, essentially macrodosing, it's not good in the long term.
The long term health impacts of taking prescription stimulants at recommended doses for on-label management of disorders is well understood and extensively studied/documented. There's not a psychiatrist that's not going to take this and other factors into consideration when prescribing it and any decent one is going to discuss medication breaks with their patients they prescribe them to. Prescription stimulants aren't perfect but it's currently the most effective treatment that's broadly applicable and well-tolerated.
A lot of people are critical of prescription stimulants without presenting a comparable alternative that will allow disordered people (particularly adults) to maintain the ability to function, be productive and maintain happiness in our current society with it's expectations and capability requirements.
The alternative is easting healthy organic foods, pasture raised meats, and exercise. Even weed/DMT/LSD is loads better than 'adhd' medication - and might actually change your way of thinking.
In my experience people who take adderall while partying do it to stay awake longer to party with other drugs or booze. In practice for most people that “high” isn’t really a thing. At least not with anyone I know who is prescribed it or sometimes takes it recreationally. Meth on the other hand? Yeah that’s going to give you a very noticeable high.
Please browse https://www.reddit.com/r/StopSpeeding/ (probably nsfw) for many stories of people struggling with prescription stimulant abuse. These people aren't taking it because it keeps them up longer for drinking.
I'm not denying that you can abuse prescription stimulants by taking large doses to get high but most people aren't taking 10-30mg a day and experiencing meth like feelings of euphoria. Especially with extended release formulations. It's also much harder to maintain the regular abuse of a prescription stimulant without resorting to illicit acquisition since most psychiatrists avoid prescribing high enough doses to make that feasible.
I can't speak for every person who abuses prescription stimulants but I've met people that do and they always had a meth or other addiction in their past and were either buying from dealers or seeing multiple doctors/pharmacies. It's been a while since I've run into someone with that problem though so I don't even know if the latter strategy is effective anymore. I assume the feds maintain some kind of database these days.
Thanks for the clarification, was just quoting from Scott Siskind's article which focuses on Adderall. I was responding to the suggestion that adderall is a mundane drug and doesn't get a person high.
I don't think that would be that hard to disprove, but I was trying to pull a quote from the article they linked.
Wikiopedia says Strattera can lead to increases in dopamine, whether that's relevant to that case I don't know.
> In my eyes, the only problem I had is that I thought school was a meaningless chore. Should we make children take meth because they don't like the system they're in?
This is what the problem was for you. It's quite a leap from there to assume that all children on ADHD medications also happen to have the same problem.
For many people with ADHD, the difficulty is beyond "the system they're in". Being regularly late to events, zoning out when talking to someone, living in a chaotic/messy living space etc. (common problems with those with ADHD) will still be a problem in a hypothetical better school system or post-scarcity communism society.
>Looking back it seemed incredibly easy and 'hand wavy' for the doc to just shut up the parent and schools and write up a prescription to 'solve the problem'
Exactly. The diagnosis is a tool for the system to give it a veneer of scientific legitimacy. There is no truth only power. In living memory, being gay was a diagnoseable disorder. In some countries political dissidents would be deemed insane and committed to institutions. Psychiatrists used to hand out lobotomies and electric shocks to anyone they felt like.
You underestimate college students because that is exactly what we did in college. People went to their doctor, faked hyperactivity, and were given adderall which they then sold to other students. I'm sure your ADD is horrible but try telling someone taking these drugs to stop. They won't. They depend on it too much and it's become part of their personality, and their belief that it is what they need.
Personally I'd really really appreciate if you would dial back the medication shaming a fair amount. As someone who can function with a lot of effort and the support of medication and who has gotten into several rough spots in life when I've suddenly run out of meds and have needed to motivate myself independently to refill them... please don't opine on what other people's experiences are.
Additionally, Adderall and the like aren't just like +2 INT boosts - the stimulants have a different affect on most people with ADHD than it would on a regular person... so whatever you've experienced abusing the medication is probably quite a bit different from what I'll experience using it.
Sounds "Just. Like. Oxy." in that people who have no idea what they're talking about go based on their gut feelings as if science and medicine should yield to their imagination:
I mean I'm sure your diabetes is horrible but try telling someone taking insulin to stop. They won't. They depend on not being in a diabetic coma too much! And not slipping into a diabetic coma becomes a part of their personality.
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ADHD doesn't mean hyperactivity despite hyperactivity being in the name. For me not taking ADHD medication results in what your proclivity for drug abuse was gaining you: the super human ability to focus on one thing for hours and hours at a time.
The difference is when the drugs you were abusing wore off, you'd go back to being able to do other things. I'd just keep being prisoner of whatever I'm doing indefinitely. It's an awful feeling to know you have to do something else, you really need to switch tasks right now, but it's like you're a prisoner in your own mind, just stuck.
So subjecting myself to that isn't really something I'd willingly... is that surprising?
I mean I've personally requested lower doses of medications, leaned towards less "intrusive" delivery methods like metabolized extended release versions, and stopped when I was injured and unable to do much (being stuck mentally wasn't a big deal when I was physically stuck)
But even if someone else dealing with this doesn't want to do that, I don't blame them. It's an awful disease that deserves proper treatment. Some dumb drug abusing kid isn't going to change that.
That's only true if you squint real hard. Might as well say people are addicted to oxygen or food if you're going to oversimplify that far. Plenty of people are able to learn meaningful coping strategies for their ADHD and choose to go off medication (especially those medicated from a young age), or at least off of stimulant medication, choosing instead to treat their disease with non-stimulant options. You'd also have to ignore the fact that they're, umm, different drugs, and do different things. The pain relief granted by opiates, along with them being chemically addictive and the marketing put forth by Perdue Pharma leading to addiction, for which they've paid billion of dollars in fines. There have been no such issues for AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp.
The thing about the drugs being different is the results on people's lives. Off medication and unmanaged, people suffering from ADHD go into depressive slumps of executive dysfunction and are unable to perform their EDLs (EveryDay Living activities; showering, putting on clothes, feeding one's self, using the bathroom, exercising), never mind things like cleaning, holding down a job or paying rent. Most are able to keep at the same dosage for the majority of their lives.
That's not what people happens to people chemically addicted to Oxy. They need more and more to get the same effect, and chase after it to the point that many have become hooked on heroin, absent a prescribed supply of Oxycontin. While on the drug their lives turn to shambles, getting fired from work and losing their jobs and then their housing and end up living on the street.
That difference is entirely material to the discussion. If people are able to make more of themselves on a particular medication, society is able to accept that a medication is good, rather than bad. That may be a tough pill for some to swallow, especially those that want to reject traditional societal norms for judging a person's life. Another tough pill is that the idea that Adderall blunts a person should really be considered a fringe belief these days, given how many people use Adderall to better their lives.
Are their people that abuse Adderall? Sure. Are their many more people that don't, and live much richer lives thanks to prescribed medication from a doctor? Absolutely.
ADHD is an ADA-recognized disability. I doubt you’d support secret limits on mobility scooter orders because college kids sometimes steal golf carts. Why is this different?
Because Adderall is 100% pure speed. A handful of Adderalls is more fun than a bag of cocaine (which is going to be more like 5% purity and adulterated with god knows what).
Don't talk out of your ass. Cocaine comes with a much, much bigger euphoric rush than even methamphetamine, which has a much bigger rush than amphetamine. If your coke is less fun than some focus enhancement, it's because somebody sold you a gram of baking powder.
Basically all stimulants can be categorized by a level of euphoric rush, and a level of focus they provide. Caffeine sucks at both, methamphetamine rocks at both, cocaine's good for a body rush but isn't very good for focus, and amphetamine comes with relatively little euphoria for a methamphetamine-comparable level of focus.
This is especially hilarious as I, a person with ADHD, am basically on speed whenever I loose access to Adderall. I would strongly encourage you to gain a better understanding of ADHD and other neurodivergent forms before continuing to speak on the topic.
>A handful of Adderalls is more fun than a bag of cocaine
Yeah, this is fear mongering; and I doubt any abuse you are seeing is actually happening on any sort of scale. To imply adderall is more fun than Cocaine/Cocaethylene is a completely strange assertion given cocaine's continued and greater penetration despite the fact it's a highly controlled schedule 2 drug. If you could have more fun with adderall, why would you spend more money on cocaine?
> Not to take the wind out of your sails but adderall is also schedule II.
OP was correct, cocaine is much more highly controlled despite sharing the same legal category. It’s only used in certain surgical procedures. You can’t get a prescription for it.
A choice must be made. Either be more restrictive and controlling meaning that some people that need the drugs don't get them. Or be less restrictive and controlling meaning that some people you think shouldn't get the drugs get them.
There's other ways to realign incentives. A buy back program would do a lot honestly to restrict the supply. A lot of people who got them for legit purposes would still end up with a ton leftover when they would get their next prescription. If they were able to get more money returning them to the pharmacy or counting them towards their next prescription than selling them to other students, that's what they would do.
If we're still talking about ADHD medications then... I have no idea where you're coming from. ADHD medications are very tightly controlled - if you accidentally double dose a few times and need an early fill you're going to get grilled (or even denied) by the pharmacist. There is a small margin for error but for the most part people using ADHD medications get precisely what they need to get to the next drug refill and not a pill more.
> if you accidentally double dose a few times and need an early fill you're going to get grilled (or even denied) by the pharmacist
That's not a thing. Nobody is getting grilled coming in early for their stimulant medications. They just say "come back in a couple days" and "have a nice day." I've filled multiple stimulant meds in a period of 2 weeks from the same doc and same pharmacist. Neither care (I dumped out a drug that had side effects so I needed something else).
If people double up, after they run out they just don't have pills for a few days until they get another fill.
That's honestly pretty much what I said: if you run out and need to refill early it's a struggle. A lot of ADHD medications come with strong withdrawl symptoms so "don't have pills for a few days" for me will mean... day 1: sleep for like twenty hours straight and miss work, day 2: have massive headaches all day and miss work, day 3+: maybe be able to attend work? Certainly struggle to actually perform my job duties.
So running out of meds is something that's highly disruptive to my life and I'll always try and minimize gaps if they do occur.
I am prescribed to take one pill each day. I prefer to keep this up on the weekends because I like being able to function even when I'm not being paid to. I can only fill a prescription once a month. The pill bottles have 28 pills in them.
Most people I knew who were on them weren't taking the dosage they were being prescribed. The side effects were too much taking it daily, so they would just use it if they were spending a lot of time in the library that day, and would end the month with half the bottle still by the time they reupped. Just because you have ADHD and benefit sometimes from these meds doesn't mean you feel great being on them 100% of the time nor need to be taking them if you are not doing anything mentally demanding that day. It's basically meth lite, after all.
My experience is that I feel significantly better when I am on my meds and am able to function consistently. I envy people who function well enough off their meds that they can be choosy about when they take them. I have no experience with meth but my understanding is that it is only superficially similar to meth.
Most ADD individuals skip doses periodically. Sometimes because they forget (we're treating an illness that causes you to get distracted, remember), or they slept in on the weekend and don't want to mess up their sleep schedule, or they simply don't have anything they really need to be able to pay attention to that day, or maybe they don't need their second dose in the day that particular day.
Unlike, say, antidepressants, there's no real backswing on off days: you just revert to your pre-medication attention levels which, especially in the case of people who got diagnosed later than usual, they have coping mechanisms for.
This results in the average ADD-medicated patient having a couple pills leftover each month.
do you understand how often there are issues filling one's adhd prescription on time even before the shortage? Almost every month the pharmacy is out of stock for a couple days. Very few people sell their couple of extra pills, they are saved for the inevitable delays in filling scripts.
And honestly? Why is this even being discussed, as if college kids getting adderall to study for math tests is some societal scourge ruining lives or something? Who gives a shit and why is it an issue that justifies making life difficult for people who are prescribed it?
Well, IMO, it puts everyone into a mental arms-race reminiscent of steroid use in bodybuilding competitions.
If you told me I was going to take a standardized test where only the top 10% make the cut, and everyone serious about winning is taking a mental PED, then yeah I am going to feel intrinsic pressure to step-up and also engage in that mental arms race. I would've been just as happy to not do that if I were given a more level playing field.
It's no secret that there is a war going on to commoditize attention. I want to live in a world where people hone their ability to push back against having their attention leeched not one where everyone raises their baseline to cope temporarily.
I also have to think that, long term, it's kind of disrespectful to those with ADHD. If expectations of attention rise due to uptake in mental PEDs then where does that leave those who were originally disadvantaged? They lose their ability to exist on a more level playing field.
Bit of a tangent, but many years ago when I was wrapping up college, I was in a Calc III class over summer. The course was being taught at an advanced pace and basically everyone in the class was struggling after the first exam. The professor addressed the class about the poor performance and then called out a student in the front row. The professor said, "You! You did well on the exam. What was your secret to studying?" and, not missing a beat, the student responded, "Adderall!" I took the hint, bought some from a friend, and suddenly found myself passing the class with flying colors. It felt good in the moment, but honestly only because I wasn't being graded on a curve. It would've been wildly demoralizing if I'd been in direct competition with my peers.
I know life isn't fair and it's a pipedream to clamber on about desiring a level playing field, but surely we can agree that physical fitness competitions are more interesting when they are separated between "natty" and "enhanced" competitors? And that if we eliminated that separation that those without PEDs are disadvantaged? I don't see society making that sort of separation for mental fitness and so I am concerned about letting stimulants loose on the population.
What is "disrespectful to people with adhd" is fucking with our med supply in order to prevent the horrific scenario of someone studying for a math test past their bedtime. Like, surely you see that right?
I want to move on with my life, instead I need to play games every couple weeks filling my prescribed meds because people are resentful that their peers back in college might have studied longer for a test? Are you fucking kidding me.
I'm still in recovery from abusing addy off-prescrip. I was citing an experience I had a decade ago which shaped my opinion of stimulants for the rest of my life. I wasn't trying to offend you personally. I was just sharing an opinion. Chill.
> I am concerned about letting stimulants loose on the population.
They already have been. It's not hard at all to get an Adderall prescription. Just Google "ADHD symptoms" (the main one being trouble focusing) then go to your doctor and tell them you have those.
I'm not interested in protecting the people that game their doctor. They decided on their own they wanted the drug and dishonestly represented themselves to obtain it. That's their own prerogative, if that causes problems then that should not result in punishment for those acting with honesty.
This is not "just. like. Oxy." in so many cases. Many of these were people in pain management with zero deceit involved on the side of the patient.
Left handedness used to be about 2% of the US population. Now it's about 12%.
While it could be that somehow we've got an epidemic of left-handedness that blossomed in the 1920s, what's much more likely is that we've gotten more accommodating and understanding of left handed people, so there was less incentive to fit the mold of right handed folks.
I'm sure there were people who were alarmed at that rise, who felt that we didn't really need left handed tools and accommodations for the "2% of people who are left handed", but when you made those things available, we stabilized at about 12%.
Antidepressants and ADHD meds are, imo, in a similar place -- we've increased our understanding, we've increased our accommodations, we no longer force the people who experience those maladies into the stress of acting 'normal'.
Once you remove demonization, of course diagnosis are going to skyrocket. When it's no longer a scary thing to admit depression, ADHD, or autism, it becomes easier to get evaluated and care for them. I experience depression, I am on an SSRI, it helps me a TON. Historically, I might have been involuntarily committed or been told to "deal with it". I guarantee you I would not be as successful as I am now if I didn't have the support I do.
(Similarly, I expect you see a lot more people being "out" in the LGBTQ+ community as a result of a similar phenomena. Once it's no longer criminal or "get lynched" territory, we see numbers of gay and trans folks increase.)
These things seem like fads. They usually aren't, they are usually the case of a particular mode of people being pressured to be silent and invisible. When you remove that negative stigma, the revert to the mean can be dramatic, but it will stabilize at a new normal level.
I've also noticed family members benefit greatly from SSRIs. The main skeptic point I have is I've also seen them absolutely get wrecked by what appears to them as supply chain failures (usually because they're unable to get a meeting with a physician in time for refills and no physician will grant them a "bridge" to the next appointment). Of course as we saw during COVID, supply chain failures of all sorts are possible even when society has not collapsed.
From the outside one of the biggest concerns I have is one of these supply chain failures will put them in even worse place than had they never taken them, as I've personally seen their withdrawal symptoms look far worse than their unmedicated baseline. It seems to be a "better day to day" with the added risk of extreme withdrawal and associated risks during these few in a lifetime supply failures.
I would expect withdrawal from almost any medication for any chronic medical condition to be worse than baseline.
I’ve been allergic to milk for at least 15 years. I didn’t know it until 3 years ago. Now that I’m not ingesting a toxic substance every day, any accidental consumption has an extremely bad reaction.
It’s similar with my bipolar medication. Now that I don’t spend half of every day trying to not kill myself, I don’t have the tolerance I used to for paranoia, psychosis, and compulsive thoughts.
There's a swath of people who (would) benefit from SSRIs that don't have day to day suicidal ideation, but might have it during the intense withdrawal process. The compounding issue is these supply chain disruptions by their very nature are correlated with stressful events like moves, natural disasters, foreign travel with unexpected extensions, etc.
This mere observation is not meant to advise someone for or against taking SSRIs.
I second this feeling, it seems like not only they are overprescribed but it's done at very young ages. Doctors just throw ADHD at signs of hyperactivity.
The idea of creating generations after generations unable to function without drugs seems a social disaster.
The real answer (IMO) is that ADHD is both under-diagnosed and over-diagnosed. I know many people who would benefit from a ADHD diagnosis, but aren't diagnosed yet, and just kind of struggle through as best as they can. On the flip side, it's also somewhat common for people to be diagnosed incorrectly (either due an over eager doctor, or because they sought out the diagnosis to get the drug).
So really, it's a question of improving accuracy overall, not just "let's make things stricter" (which would make it even harder from those are not diagnosed yet).
(I know you mentioned prescribing, not diagnosing, but I think it's a broader issue beyond just the drug).
Adults, females and minorities are all under-diagnosed compared to the estimated 2-4% of the population with ADHD. And I'd guess that diagnosis rates are higher across the board in the USA than elsewhere - I read the other day only 1 in 1,000 adults in Scotland have been diagnosed with ADHD, at least an order of magnitude fewer than those who would benefit from it.
Ok, then the DEA should do something like go after pill mills and overprescribers or at the very least apply quotas based on time of starting treatment, ie limiting new diagnoses. The latter should be easy to do because of all the scheduled drug regulations and tracking they have already. Making it so everybody with a medication gets screwed is idiotic.
I don’t even think it’s worth stopping people from taking it personally, anybody willing to fake the medical system could just as easily take street meth instead, which will be a lot worse for society. Reminds me of when the heroin epidemic went into overdrive after the DEA cracked down on pain clinics, then leading to the fentanyl epidemic, and how many deaths? I’m sure it was worth it though
