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Everything you said is true, but the surrounding context is still incredibly important. There is a reason ADHD is such an open target for this behavior. We hav

Everything you said is true, but the surrounding context is still incredibly important. There is a reason ADHD is such an open target for this behavior. We have a very significant problem with adult ADHD diagnosis and treatment in our healthcare system. In the overwhelming majority of cases, it simply isn't being done. In order for an adult with undiagnosed ADHD to receive treatment, they must navigate our healthcare system. That means finding insurance, finding providers, and setting appointments. Every one of those steps is hell for most people living with ADHD symptoms: they literally have an untreated disorder making those steps too difficult. And even when they do manage all of these steps, there is a very serious lack of education in healthcare about adult ADHD. Many doctors have an outdated belief that ADHD is a child's disorder, and that patients will simply "grow out of it". Studies have shown very thoroughly that this is not the case. And even when you do get a diagnosis, there is a serious hesitance to prescribe medication. There are two familiar narratives about stimulant medication. Despite being at odds with each other, both narratives are true. Stimulant medication is, in the overwhelming majority of cases, the single most effective part of treatment. Without stimulant medication, most ADHD patients are effectively stuck in therapy: they need to change their behavior to treat their symptoms, but it's their symptoms that are driving the behavior! The other story: stimulant medication is addictive and dangerous. People see their lives fall apart in addiction. It's a very serious problem that demands our attention. This is the story seen by law enforcement: particularly in the DEA. That is, after all, the set of circumstances they exist to respond to. So what do we do about it? Ban the substances? That clearly doesn't work. And we shouldn't simply be trying to keep every person from using them: the positive effects are incredibly positive. Another thing to be aware of: stimulant medication helps fight addiction, too. People with untreated ADHD are very likely to enter addiction, because they have a chronic deficit in stimulation. Giving those people stimulant medication resolves that deficit, and has been shown to very significantly reduce addiction, often even eliminating the addiction completely. This situation with Cerebral certainly increased the negative consequences of stimulant medication. It also increased the positive consequences. People who do not have ADHD, and should not be given stimulant medication were provided an easily abusable system to obtain that medication. People who do have ADHD and benefit greatly from stimulant medication were provided an easily useable system to obtain that medication. Please, for the love of all people, don't let us get so caught up in the negatives that we outlaw the positives! We need to take a long and hard look at how our healthcare system is failing us. It's failing potential addicts by playing fast and lose, and it is failing those with untreated ADHD by giving them impossible hurdles. Each failure demands the other as a solution. We need to break this cycle.

opportune 4y ago
I used online telehealth (through a more legit provider) to seek treatment for ADHD just because before COVID, it was very hard to find psychiatric services that catered to adult ADHD. The same is true for many others I’ve talked to: they had been meaning to seek adhd treatment for a while (and in many cases had done so, only to be diagnosed with depression, or to be told that they were doing well enough in life that they didn’t need treatment) but it was such a daunting process that most hadn’t gone through with it. There are of course perverse incentives when it comes to these kinds of businesses (nobody would use them if they were extremely stingy), so they do need to be held to a standard that prevents them from just becoming pill mills. OTOH I think the cost/benefit to society is maximized when barriers to care are lower than what they were pre-telehealth, even if it means some people are just going to abuse the system, especially with adhd meds which are not that addictive or harmful, contrary to popular opinion (that stereotype comes from much more hardcore stuff like smoking and injecting large amounts of meth) - compared to opiates or benzos it’s really no contest that prescription stimulants are less problematic and less addictive. What concerns me is that so many pundits are listening to the DEA bozos that all the stimulant shortage (which, btw, impacts people who have been stable on adhd meds for decades almost as much as those who only started treatment during the pandemic) is due to the increase in diagnoses from telehealth, when in fact it’s due to arbitrary production quotas set by the DEA that can easily be raised. The fact we let the DEA determine how much of a prescription medicine can be made, allowing formal and above board medical care to be impacted, is absolutely insane to me. This is literally the war on drugs preventing longtime patients from getting the care they’ve been relying on for decades, just because it became easier to get treatment. The attitude should be that 5 abusers are a small price to pay for 1 legitimate patient getting the care they need, not that 5 abusers need to be stopped so bad that 20 legitimate patients go without treatment.
PragmaticPulp 4y ago
Primary care doctors have been treating ADHD for a long time. Making an appointment with a primary care doctor and showing up to it isn’t that much harder than making an appointment with a telehealth doctor and showing up to it. > Stimulant medication is, in the overwhelming majority of cases, the single most effective part of treatment. Let’s not downplay the effectiveness of non-stimulant ADHD medications. They’re actually quite powerful at improving cognition and can have even better outcomes in many people, especially those prone to anxiety, rumination, or insomnia (all of which can be substantially worsened by stimulant medications). The downside is that the non-stimulant medications can take some time to become fully effective, which has created a false belief that they’re worse than stimulants. Telehealth pill mills like Cerebral only make the situation worse, as the doctors have no interest in long term patient outcomes other than writing as many Schedule II prescriptions per hour as they can. This isn’t healthy.

opportune 4y ago

I used online telehealth (through a more legit provider) to seek treatment for ADHD just because before COVID, it was very hard to find psychiatric services that catered to adult ADHD. The same is true for many others I’ve talked to: they had been meaning to seek adhd treatment for a while (and in many cases had done so, only to be diagnosed with depression, or to be told that they were doing well enough in life that they didn’t need treatment) but it was such a daunting process that most hadn’t gone through with it. There are of course perverse incentives when it comes to these kinds of businesses (nobody would use them if they were extremely stingy), so they do need to be held to a standard that prevents them from just becoming pill mills. OTOH I think the cost/benefit to society is maximized when barriers to care are lower than what they were pre-telehealth, even if it means some people are just going to abuse the system, especially with adhd meds which are not that addictive or harmful, contrary to popular opinion (that stereotype comes from much more hardcore stuff like smoking and injecting large amounts of meth) - compared to opiates or benzos it’s really no contest that prescription stimulants are less problematic and less addictive. What concerns me is that so many pundits are listening to the DEA bozos that all the stimulant shortage (which, btw, impacts people who have been stable on adhd meds for decades almost as much as those who only started treatment during the pandemic) is due to the increase in diagnoses from telehealth, when in fact it’s due to arbitrary production quotas set by the DEA that can easily be raised. The fact we let the DEA determine how much of a prescription medicine can be made, allowing formal and above board medical care to be impacted, is absolutely insane to me. This is literally the war on drugs preventing longtime patients from getting the care they’ve been relying on for decades, just because it became easier to get treatment. The attitude should be that 5 abusers are a small price to pay for 1 legitimate patient getting the care they need, not that 5 abusers need to be stopped so bad that 20 legitimate patients go without treatment.

PragmaticPulp 4y ago

Primary care doctors have been treating ADHD for a long time. Making an appointment with a primary care doctor and showing up to it isn’t that much harder than making an appointment with a telehealth doctor and showing up to it. > Stimulant medication is, in the overwhelming majority of cases, the single most effective part of treatment. Let’s not downplay the effectiveness of non-stimulant ADHD medications. They’re actually quite powerful at improving cognition and can have even better outcomes in many people, especially those prone to anxiety, rumination, or insomnia (all of which can be substantially worsened by stimulant medications). The downside is that the non-stimulant medications can take some time to become fully effective, which has created a false belief that they’re worse than stimulants. Telehealth pill mills like Cerebral only make the situation worse, as the doctors have no interest in long term patient outcomes other than writing as many Schedule II prescriptions per hour as they can. This isn’t healthy.