4 ms·

This is a exactly the kind of puritanical catch-22 that entrenches every corner ADHD treatment. “Oh, your justification for access to the high-inducing, party d

This is a exactly the kind of puritanical catch-22 that entrenches every corner ADHD treatment. “Oh, your justification for access to the high-inducing, party drug of amphetamine is that it’ll cure your lack of focus? Well, if these dangerously addictive drugs so effective, then surely you can handle 30 day prescriptions with no refills.” God forbid your prescription runs out on a weekend or holiday when your doctor’s office is closed. And don’t even think about shopping around for multiple scripts because that’ll just label you as a drug addict. The only winning move is to take half-doses on down days and build up a small stash of emergency medication.

opportune 4y ago
100% this. The worst part about ADHD treatment is all the disruptions of care to prevent people trying to abuse it. I personally don't give a rat's ass if people want to take adderall to go out and party or masturbate either. They'd probably have fun with less negative health effects or risk of fights/belligerence compared to alcohol... But for some reason the government (the FDA) and medical field in general cares about abuse a lot. In the past few weeks, Cerebral got labelled a pill mill by the FDA/execs and as a result almost all ADHD telemedicine patients are having a hard time getting prescriptions filled. Sending a prescription to multiple places sequentially (because they keep refusing to fill it) or calling a pharmacy in advance to ask if they'd fill the prescription runs the risk of being labelled a drug seeker, and any power-tripping retail pharmacist - who doesn't know anything about you at all - can just refuse to fill your prescription if they want. Asking your provider for a higher dose is also anxiety-inducing for similar reasons. The worst part is, people with ADHD still build a dependence/tolerance on amphetamines/methylphenidate. So running out of your medicine is really disruptive - not only do your symptoms go untreated, but they become worse than they'd be if you were unmedicated for a long interval, plus you have to deal with things like not feeling fully awake, being hungrier, lethargic, sleeping more while your body adjusts back to being unmedicated. But for some reason that's acceptable as long as we prevent people from taking amphetamines for fun.
- sascha_sl 4y ago
  I found it really useful to cycle single doses between 5mg/10mg and ocasionally skip it entirely, when I know it wouldn't be essential. (Usually the skip sorts itself out when I forget I have them. You'd think lingering processing deficiencies would be obvious enough to remind me, but apparently not.) I've been avoiding higher doses because this setup works well enough that I don't want to disrupt the status quo and I keep hearing from friends that build a dependence and even one who went off them entirely after adverse reactions on very high doses. Fortunately I have a doctor who agreed this was a good idea and writes me prescriptions for different strengths.
- hombre_fatal 4y ago
  It's pretty obnoxious how pharmacies and especially pharmacists have this kind of discretion. Just put my pills in the bottle, dude. I got turned down for filling an Adderall prescription at a CVS because the pharmacist didn't like that I was paying in cash (credit card) as an uninsured uni student. Didn't offer to call my doctor's office to confirm the script. Just said oh, I don't like that you're paying in cash so I'm not going to fill this :). I fortunately get 90-day prescriptions (how long will that last?) and every time I refill, I have anxiety throughout the whole process (the checkup, the pharmacy) until I have pills in hand. Every time I feel like it's going to be the day I somehow have to jump through more hoops like my friend who has to have his pills counted every two weeks for his painkillers.
  - saltminer 4y ago
    I'm jealous, my insurance will do 90 day fills on everything but methylphenidate.
matheusmoreira 4y ago
If doctors are concerned about abuse, they can just prescribe lisdexamphetamine instead of dextroamphetamine. Abuse potential, addiction and the subjective high associated with these drugs are all related to the speed it enters the brain. Lisdexamphetamine gets slowly converted into dextroamphetamine once in the blood stream. Much safer drug in general, not sure why it's not as widely used as Adderall.
- projectazorian 4y ago
  In the US, it’s still on patent so it’s more expensive for the patient and more insurance paperwork for the doctor. Comes off patent next year though. My experience was that I had to ask my doctor to switch, but once I asked, they were happy to accommodate.
- throwaway284534 4y ago
  You’re absolutely right. I actually chose Vyvanse for that same reason, and yet the limits are still applied as if the drug is as abusable as Adderall. Personally, I have no difficulty tapering doses on the weekends, even pouring out half the capsule’s powder. I once asked my doctor if they could prescribe sixty 20mg pills instead of thirty 40mg pills. Half doses when I’m taking the day off, right? Wrong. Insurance only fills 30 pills per month and they have to be of the same potency. Ironically, if you asked your doctor to give you the 70mg pills, you could dump the excess powder for an emergency reserve and end up with far more medication! The rules are totally made up and there’s no actual reason for limits other than the projection of “being tough on drug abuse.”

opportune 4y ago

100% this. The worst part about ADHD treatment is all the disruptions of care to prevent people trying to abuse it. I personally don't give a rat's ass if people want to take adderall to go out and party or masturbate either. They'd probably have fun with less negative health effects or risk of fights/belligerence compared to alcohol... But for some reason the government (the FDA) and medical field in general cares about abuse a lot. In the past few weeks, Cerebral got labelled a pill mill by the FDA/execs and as a result almost all ADHD telemedicine patients are having a hard time getting prescriptions filled. Sending a prescription to multiple places sequentially (because they keep refusing to fill it) or calling a pharmacy in advance to ask if they'd fill the prescription runs the risk of being labelled a drug seeker, and any power-tripping retail pharmacist - who doesn't know anything about you at all - can just refuse to fill your prescription if they want. Asking your provider for a higher dose is also anxiety-inducing for similar reasons. The worst part is, people with ADHD still build a dependence/tolerance on amphetamines/methylphenidate. So running out of your medicine is really disruptive - not only do your symptoms go untreated, but they become worse than they'd be if you were unmedicated for a long interval, plus you have to deal with things like not feeling fully awake, being hungrier, lethargic, sleeping more while your body adjusts back to being unmedicated. But for some reason that's acceptable as long as we prevent people from taking amphetamines for fun.

sascha_sl 4y ago
I found it really useful to cycle single doses between 5mg/10mg and ocasionally skip it entirely, when I know it wouldn't be essential. (Usually the skip sorts itself out when I forget I have them. You'd think lingering processing deficiencies would be obvious enough to remind me, but apparently not.) I've been avoiding higher doses because this setup works well enough that I don't want to disrupt the status quo and I keep hearing from friends that build a dependence and even one who went off them entirely after adverse reactions on very high doses. Fortunately I have a doctor who agreed this was a good idea and writes me prescriptions for different strengths.
hombre_fatal 4y ago
It's pretty obnoxious how pharmacies and especially pharmacists have this kind of discretion. Just put my pills in the bottle, dude. I got turned down for filling an Adderall prescription at a CVS because the pharmacist didn't like that I was paying in cash (credit card) as an uninsured uni student. Didn't offer to call my doctor's office to confirm the script. Just said oh, I don't like that you're paying in cash so I'm not going to fill this :). I fortunately get 90-day prescriptions (how long will that last?) and every time I refill, I have anxiety throughout the whole process (the checkup, the pharmacy) until I have pills in hand. Every time I feel like it's going to be the day I somehow have to jump through more hoops like my friend who has to have his pills counted every two weeks for his painkillers.
- saltminer 4y ago
  I'm jealous, my insurance will do 90 day fills on everything but methylphenidate.

matheusmoreira 4y ago

If doctors are concerned about abuse, they can just prescribe lisdexamphetamine instead of dextroamphetamine. Abuse potential, addiction and the subjective high associated with these drugs are all related to the speed it enters the brain. Lisdexamphetamine gets slowly converted into dextroamphetamine once in the blood stream. Much safer drug in general, not sure why it's not as widely used as Adderall.

projectazorian 4y ago
In the US, it’s still on patent so it’s more expensive for the patient and more insurance paperwork for the doctor. Comes off patent next year though. My experience was that I had to ask my doctor to switch, but once I asked, they were happy to accommodate.
throwaway284534 4y ago
You’re absolutely right. I actually chose Vyvanse for that same reason, and yet the limits are still applied as if the drug is as abusable as Adderall. Personally, I have no difficulty tapering doses on the weekends, even pouring out half the capsule’s powder. I once asked my doctor if they could prescribe sixty 20mg pills instead of thirty 40mg pills. Half doses when I’m taking the day off, right? Wrong. Insurance only fills 30 pills per month and they have to be of the same potency. Ironically, if you asked your doctor to give you the 70mg pills, you could dump the excess powder for an emergency reserve and end up with far more medication! The rules are totally made up and there’s no actual reason for limits other than the projection of “being tough on drug abuse.”