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“The letter said the DEA would ensure that “the manufacturing of controlled substances used to treat ADHD is driven by a legitimate need and not improperly driv

“The letter said the DEA would ensure that “the manufacturing of controlled substances used to treat ADHD is driven by a legitimate need and not improperly driven purely by profit motive, pressure from marketing firms, or a desire to obtain more market share – all factors that led to an oversupply of opioids during the prescription opioid crisis.” As much as I hate to say it, this is fairly responsible behavior by regulators, who are likely betting that people without a real need will simply churn when it gets tougher to find some. That said, it is sad that those with a disease that makes it difficult to plan and execute have to do exactly that to get their treatment.

akavi 4y ago
I'm not sure I'd expect people with a real need for a medication to address executive dysfunction to be the set of people who persist in acquiring something when it becomes difficult to do.
- kqr 4y ago
  Yeah, this is the classic "you have to be healthy to put up with the healthcare system" problem.
- ethanwillis 4y ago
  This is exactly the problem. I was diagnosed with ADHD very late (around 29) and the "effects" have always been there impacting my life course, coping strategies, and so on. The "telemedicine" apps that everyone derides have been infinitely helpful. I won't discount that they've made it easier for non-legitimate "users" to acquire adderall, but they've also been extremely beneficial for people like myself. Without them I would surely still be un-medicated and struggling much much more. Even after being diagnosed it took me well over a year to make the "choice" to start taking adderall or to "become medicated" due to a mixture of things. 1. My inability or basically handicap that made it hard to follow through on multiple doctors visits in person, on site. 2. The worry about the perception of being an "adderall user" 3. Worries about possible addiction due to society's perception and *also* drug abuse in my family history 4. The lack of solid real information on what the process would look like. So uncertainty. 5. The fear that these telemedicine apps wouldn't connect me with an actual professional who would actually listen to my concerns (much like often happens in real life office visits where a doctor is stressed about time). While the telemedicine experience isn't perfect and neither would be in-office/in-person visits. It is good. What hasn't been good has often been problems with pharmacies not wanting to honor prescriptions written by professionals working for these companies. Or with the various shortages over the past year. I started on 10mg twice a day over a year ago and I was asked if I wanted to increase my dosage, but I wasn't pushed to do so. It was an actual discussion if the dosage level was working properly, asked about my schedule, asked about the structure of my life and so on to determine if it was working as intended and not causing any ill-effects. I'm still on the same dosage a year later with no "pushiness" to increase my dosage. I definitely can't act like this isn't anecdotal, it is. But without this option I would be unmedicated. And with deliberate shortages I've had periods where I was forced to go without my medication and it felt like night and day. Which made me realize quite quickly just how debilitating ADHD had been for me for a long time. So the idea of creating these deliberate shortages or doing away with telemedicine altogether for ADHD because of a lack of desire to find the appropriate regulation or measures that would be acceptable to allow it to continue to exist. It would be, and has been in some instances, extremely detrimental. I can imagine, and am scared to think of, a situation in which I first lose access to my adderall prescription by a deliberate shortage, followed by a gutting of telemedicine providers. How can I with my "condition" exhibit "high levels" of executive function required to jump through many hoops because of others taking advantage of systems meant to help people like myself. Systems that make it accessible to receive treatment when without treatment I can't even begin to clean a small room because of this condition? The people who do take advantage of this situation will continue to do so. But I personally won't be able to. Or if I by some miracle can it won't last long until another "purge of the drug abusers" happens and a deliberate shortage renders me unmedicated for months at a time. I need the stability because the instability of these systems impacts the people who need them the most. Otherwise it's lots of up and downs and it feels extremely hopeless. edit: Ironically one of these shortages hit shortly after I got a new job and it was hard to execute which hit my reputation hard as a new hire. It's easy to say "i have a disability" but that doesn't magically make the requirements of business go away. And "federal protections" aren't absolute in the sense that you can get away with not executing to the required level. You'll be managed out on non-protected technicalities, as I was, that are still a result of the disability. And most people don't really want to have to get engaged in a lawsuit over these things and deal with the stress of being perceived as a "problem." At least I don't. I just want to be able to do my work, live my life outside of it, and so on without a ton of difficulty. And another aside, the norms of the hiring process for programmers today are hard/demanding enough in terms of scheduling for "normal" people. It's triply hard for someone like myself without medication.
andromeduck 4y ago
Why should I have to pay thousands per year to treat a condition I was born with when any junkie on the street can get it for pennies on the dollar?
- CodexArcana 4y ago
  Because our society is built on soft eugenics. If it was palatable the state would have liquified us ages ago for being a burden to society.
EdwardDiego 4y ago
Hey, definitely agree that ensuring doctors aren't handing out stimulants willy nilly is essential. But doing it by deliberately limiting supply is a brute force approach that significantly impacts people who actually need treatment. I think the belief that ADHD isn't a "real" disease permeates these decisions. In my country, cancer patients are the biggest source of morphine used to make heroin by addicts. Yet cancer patients are not subject to any of the controls placed on people receiving stimulant based ADHD medications. What I'm unsure about, is it because a cancer diagnosis is far more definitive? Or is it because it would play very poorly in the media if you made it far harder for all cancer patients to access the medication they needed, because a small percentage of them are selling it to junkies? Either way, the controls around ADHD meds are excessive.
- supersour 4y ago
  Something I'm curious about: why do you think that an excess of stimulants is societally damaging? For the past few years I'm of the opinion that these substances should be available to those who find them useful (maybe with a doctor check-in required for blood pressure and dosage regulation). While the abuse potential for adderall has a stronger case, something like methylphenidate has a relatively low abuse potential and has been shown to be neuroprotective (unlike adderall which may be damaging long term). Requiring people to go through a semi-permeable ADHD screening and visit a doctor every 3 months for refills is unnecessary load on an already overburdened health care system (I'm in Canada). Why are caffeine pills ubiquitous and accepted as a means to improve productivity, yet other stimulants are not? In my mind, this parallels the argument as to how alcohol is given a pass compared to other recreational drugs since it is already culturally accepted.
  - EdwardDiego 4y ago
    > why do you think that an excess of stimulants is societally damaging? Because of their potential for addiction, and also we know that excessive usage of stimulants can have bad physical and psychological impacts. You compared caffeine, well, that's not really comparable to stronger stimulants. Unless someone has committed murder five days into a No-Doze bender that I'm unaware of.

akavi 4y ago

I'm not sure I'd expect people with a real need for a medication to address executive dysfunction to be the set of people who persist in acquiring something when it becomes difficult to do.

kqr 4y ago
Yeah, this is the classic "you have to be healthy to put up with the healthcare system" problem.
ethanwillis 4y ago
This is exactly the problem. I was diagnosed with ADHD very late (around 29) and the "effects" have always been there impacting my life course, coping strategies, and so on. The "telemedicine" apps that everyone derides have been infinitely helpful. I won't discount that they've made it easier for non-legitimate "users" to acquire adderall, but they've also been extremely beneficial for people like myself. Without them I would surely still be un-medicated and struggling much much more. Even after being diagnosed it took me well over a year to make the "choice" to start taking adderall or to "become medicated" due to a mixture of things. 1. My inability or basically handicap that made it hard to follow through on multiple doctors visits in person, on site. 2. The worry about the perception of being an "adderall user" 3. Worries about possible addiction due to society's perception and *also* drug abuse in my family history 4. The lack of solid real information on what the process would look like. So uncertainty. 5. The fear that these telemedicine apps wouldn't connect me with an actual professional who would actually listen to my concerns (much like often happens in real life office visits where a doctor is stressed about time). While the telemedicine experience isn't perfect and neither would be in-office/in-person visits. It is good. What hasn't been good has often been problems with pharmacies not wanting to honor prescriptions written by professionals working for these companies. Or with the various shortages over the past year. I started on 10mg twice a day over a year ago and I was asked if I wanted to increase my dosage, but I wasn't pushed to do so. It was an actual discussion if the dosage level was working properly, asked about my schedule, asked about the structure of my life and so on to determine if it was working as intended and not causing any ill-effects. I'm still on the same dosage a year later with no "pushiness" to increase my dosage. I definitely can't act like this isn't anecdotal, it is. But without this option I would be unmedicated. And with deliberate shortages I've had periods where I was forced to go without my medication and it felt like night and day. Which made me realize quite quickly just how debilitating ADHD had been for me for a long time. So the idea of creating these deliberate shortages or doing away with telemedicine altogether for ADHD because of a lack of desire to find the appropriate regulation or measures that would be acceptable to allow it to continue to exist. It would be, and has been in some instances, extremely detrimental. I can imagine, and am scared to think of, a situation in which I first lose access to my adderall prescription by a deliberate shortage, followed by a gutting of telemedicine providers. How can I with my "condition" exhibit "high levels" of executive function required to jump through many hoops because of others taking advantage of systems meant to help people like myself. Systems that make it accessible to receive treatment when without treatment I can't even begin to clean a small room because of this condition? The people who do take advantage of this situation will continue to do so. But I personally won't be able to. Or if I by some miracle can it won't last long until another "purge of the drug abusers" happens and a deliberate shortage renders me unmedicated for months at a time. I need the stability because the instability of these systems impacts the people who need them the most. Otherwise it's lots of up and downs and it feels extremely hopeless. edit: Ironically one of these shortages hit shortly after I got a new job and it was hard to execute which hit my reputation hard as a new hire. It's easy to say "i have a disability" but that doesn't magically make the requirements of business go away. And "federal protections" aren't absolute in the sense that you can get away with not executing to the required level. You'll be managed out on non-protected technicalities, as I was, that are still a result of the disability. And most people don't really want to have to get engaged in a lawsuit over these things and deal with the stress of being perceived as a "problem." At least I don't. I just want to be able to do my work, live my life outside of it, and so on without a ton of difficulty. And another aside, the norms of the hiring process for programmers today are hard/demanding enough in terms of scheduling for "normal" people. It's triply hard for someone like myself without medication.

andromeduck 4y ago

Why should I have to pay thousands per year to treat a condition I was born with when any junkie on the street can get it for pennies on the dollar?

CodexArcana 4y ago
Because our society is built on soft eugenics. If it was palatable the state would have liquified us ages ago for being a burden to society.

EdwardDiego 4y ago

Hey, definitely agree that ensuring doctors aren't handing out stimulants willy nilly is essential. But doing it by deliberately limiting supply is a brute force approach that significantly impacts people who actually need treatment. I think the belief that ADHD isn't a "real" disease permeates these decisions. In my country, cancer patients are the biggest source of morphine used to make heroin by addicts. Yet cancer patients are not subject to any of the controls placed on people receiving stimulant based ADHD medications. What I'm unsure about, is it because a cancer diagnosis is far more definitive? Or is it because it would play very poorly in the media if you made it far harder for all cancer patients to access the medication they needed, because a small percentage of them are selling it to junkies? Either way, the controls around ADHD meds are excessive.

supersour 4y ago
Something I'm curious about: why do you think that an excess of stimulants is societally damaging? For the past few years I'm of the opinion that these substances should be available to those who find them useful (maybe with a doctor check-in required for blood pressure and dosage regulation). While the abuse potential for adderall has a stronger case, something like methylphenidate has a relatively low abuse potential and has been shown to be neuroprotective (unlike adderall which may be damaging long term). Requiring people to go through a semi-permeable ADHD screening and visit a doctor every 3 months for refills is unnecessary load on an already overburdened health care system (I'm in Canada). Why are caffeine pills ubiquitous and accepted as a means to improve productivity, yet other stimulants are not? In my mind, this parallels the argument as to how alcohol is given a pass compared to other recreational drugs since it is already culturally accepted.
- EdwardDiego 4y ago
  > why do you think that an excess of stimulants is societally damaging? Because of their potential for addiction, and also we know that excessive usage of stimulants can have bad physical and psychological impacts. You compared caffeine, well, that's not really comparable to stronger stimulants. Unless someone has committed murder five days into a No-Doze bender that I'm unaware of.