12 ms·

People with ADHD claim Adderall is ‘different’ now

262 points by gnicholas 4y ago

BizarreByte 4y ago
I'm glad there's no obvious shortage in Canada, this stuff has a tendency to spill over from America. I finally I was to get prescribed and it definitely works for me. 20mg of Sandoz XR, it's like magic.
- briHass 4y ago
  You may have just gotten lucky. It seems like the situation in the US is highly location/pharmacy-specific. The other variables are type (IR/XR, generic/non, etc.) and unit dosage. The worst hit seem to be 10mg/20mg generic IR Adderall, because that is usually the most popular and cheapest option. Switching to XR or to a less-common unit size (like 25mg) may increase the odds of finding it somewhere. It really is a super frustrating situation. Because of the tight controls on the drug, prescriptions are almost always sent electronically from provider to pharmacy, and any changes or transfers must go through the provider. Most providers aren't going to play whack-a-mole by continuing to transfer the script, and as the article implies, changing medication type (Ritalin/Adderall/Vyvanse) or IR/XR can have significant impact on the effectiveness and potential side-effects. Responsible providers aren't just going to flip/flop medications without at least a consultation.
  - BizarreByte 4y ago
    >Because of the tight controls on the drug, prescriptions are almost always sent electronically from provider to pharmacy, and any changes or transfers must go through the provider. Very different from where I live in Canada. I just get a written script and can take it wherever I like. The pharmacy submits the info to the provincial drug tracking program to make sure it's all kosher and when it is I'm on my way. If a pharmacy every refused to fill it I could just take the script elsewhere.
  - vogt 4y ago
    >It seems like the situation in the US is highly location/pharmacy-specific. Anecdotally, this definitely rings true. I recently moved from Dallas-Fort Worth to a VERY rural part of west Texas (population >2000). The only pharmacy within an hours drive, which is 30 minutes away in a town of ~20,000 has filled my prescription regularly. Back in DFW I know of three different people who have been unable to get their Adderall filled for months. And there's a pharmacy practically on every corner out there.
- thomastjeffery 4y ago
  The shortage is entirely arbitrary, and only exists in the US. We had a significant increase in ADHD diagnosis during the pandemic, because telehealth is much more approachable for people with untreated ADHD. Despite that increase, the DEA refused to increase the arbitrary limit for how much Adderall can be manufactured in the US. So we have an entirely avoidable shortage on our hands.
  - trafficante 4y ago
    > We had a significant increase in ADHD diagnosis during the pandemic, because telehealth is much more approachable for people with untreated ADHD. And, in typical fashion, the DEA responds to the problem in nearly the worst way possible: they announced new regulations to stop telehealth providers from writing new prescriptions for ADHD meds. I suppose this keeps the shortage from getting worse, but that’s about it.
    - dragonwriter 4y ago
      They aren’t new regulations, its the ending of the temporary suspension of the old regulations which was premised on the pandemic state of emergency, which has ended. Its bad because the pre-existing rules were bad and should have been changed instead of merely suspended based on the pandemic.
philwelch 4y ago
https://archive.ph/LIlpt https://archive.ph/LIlpt
analyte123 4y ago
Kind of bizarre that the author won’t entertain the most obvious explanation given the documented problems with many generic drugs [1]. I guess the difference in this case is that the patients can tell right away. [1] https://www.npr.org/sections/health-shots/2019/05/12/722216512/bottle-of-lies-exposes-the-dark-side-of-the-generic-drug-boom https://www.npr.org/sections/health-shots/2019/05/12/7222165...
- Waterluvian 4y ago
  The difference in Concerta and its generic is chocolate and vanilla to me. The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours. Completely unsurprised if an Adderall generic had just as significant impacts.
  - luckydata 4y ago
    the generic concerta all have a KNOWN issue with manufacturing. The slow release mechanism is mechanic, not chemical, and only ONE generic is manufactured the right way. https://www.goodrx.com/concerta/certain-generics-are-no-longer-equivalent-to-brand-name-concerta https://www.goodrx.com/concerta/certain-generics-are-no-long...
    - joezydeco 4y ago
      It's literally a plastic capsule with microscopic holes drilled in it. A sponge on one end absorbs moisture and swells at a fixed rate, slowly pushing the methylphenidate out the other side.
  - deleted 4y ago
    [deleted]
  - RyJones 4y ago
    That is exactly my experience. The brand-name Concerta is a smooth push all day, the generic is terrible.
  - 4y ago
mtlmtlmtlmtl 4y ago
[flagged]
- philwelch 4y ago
  Hush! Shh! Don't tell them! The adderall shortage is the result of a completely artificial quota set by the DEA. Those of us who use dexedrine have been mostly spared, but if the adderall users switch to dexedrine, we might start having issues.
  - WalterSear 4y ago
    I had to go with amphetamine because dexedrine was unavailable in my area.
  - thomastjeffery 4y ago
    Considering that the Adderall shortage has affected my pharmacy's supply of Concerta, you are probably just relatively lucky.
- waboremo 4y ago
  Adderall contains dextroamphetamine btw
  - mtlmtlmtlmtl 4y ago
    I know this. But it also contains levoamphetamine. But as far as I know there's no clinically proven benefit(happy to be proven wrong) to including levoamph, and it can cause more side effects. Which is why in most countries these days adderall is not really prescribed, and often isn't even in the pharmacopoeia. Why adderall is still in use in the US is an interesting question I don't have the answer to.
    - loeg 4y ago
      > But as far as I know there's no clinically proven benefit My impression of US pharma regulation and drug trials is that it would not have been approved if it did not show some benefit over the status quo. I don't know about adderall's clinical trials in particular, though.
therein 4y ago
I wouldn't be surprised if they are doing this. It should be relatively easy to test, though. I know many people that'd volunteer do run NMR or mass spec.
- awinter-py 4y ago
  interesting -- where? guessing it would be easy to collect a bunch of different brands + generics to compare
  - therein 4y ago
    Pretty much anyone with friends who study chemistry would do. The problem is, no matter what you do, it is going to be very challenging proving the chain of custody to hold them accountable.
    - awinter-py 4y ago
      point taken but also shrug -- if the machine turns up a pattern, you get it redone at a real lab
awinter-py 4y ago
the stuff in here about 'minor differences in coating could make a difference but shouldn't' is surprisingly badly researched both teva + shire manufacture a branded and a generic -- just ask them what the difference is between the two, right? and if they hang up you can write, 'both teva and shire refused to say if their generic works' I'm fairly sure this is Shire's original patent for XR beads https://patents.google.com/patent/US6322819B1/ https://patents.google.com/patent/US6322819B1/ they have a subsequent patent for a more continuous delivery system https://patents.google.com/patent/US6913768B2/ https://patents.google.com/patent/US6913768B2/ (from plasma concentration, the double-pulsed one looks as smooth as continuous delivery, but I'm guessing the brain + blood half lives are different) but the bead material is probably FDA scrutinized, and any chemical difference between the branded + generic version is in theory public knowledge; shocking nyt didn't like, call a chem lab or something before hitting send on this one the author speculating that someone is complaining about switching from an immediate release to an XR also feels bogus -- presumably I would say in my tiktok that it's a capsule instead of a tablet?
- hooverd 4y ago
  That's like baby's first chemistry lab lesson, inactive ingredients can make a big difference sometimes.
  - aksss 4y ago
    “Inactive ingredient” is a term with similar provenance as “junk dna”, “oldest human tool-making”, and “oldest humans in North America”. These terms represent a state of current understanding more than absolute truth.
- jws 4y ago
  I suppose things might have changed in ~half a century, the FDA used to care about everything. Back in the late '80s the VAX-11/750 that was part of the Siemens MRI scanners was shipped in the old blue trim color long after DEC had switched to the very chic "brown on tan" color scheme. The FDA approval for the scanner would not let them change the color of the paint because of some bleedover of medication regulation language into the equipment approval regulations.
_pwzj 4y ago
Not a doctor, just a patient: Adderall is a mixed salt, it's two stereoisomers, amphetamine and dextroamphetamine. One of them (I think it's the amphetamine) is "speedier" feeling and the other one (I think dex) is "cleaner". Dextroamphetamine is also available as a purified salt itself, as dexedrine. And I think that's more of a "kids medicine" specifically because it's less "speedy". I think there's nothing that guarantees any particular ratio comes in the product, and obviously generics have very mixed results on just how "bioequivalent" it really ends up being. I think the mixture is varying and people end up feeling like it's different because they're feeling the "speediness" change and that's the feeling they associate with being medicated with stimulants. Amphetamines are another dopamine-releasing and gaba-ergenic family of drugs and my suspicion is that in the presence of an opioid antagonist like naltrexone probably patients would not be able to distinguish between the exact mixtures of the stereoisomers but without it they probably can tell which feels "speedier" and the perception is that is how much their symptoms being treated. The dopamine-releasing loop probably is a not-insignificant part of how it treats ADHD though, dopamine-seeking is a key aspect of ADHD (do you drink caffeine or eat sugar before you go to bed, or when you wake up in the middle of the night, and then fall right asleep? that's because your brain is getting dopamine satiation finally). (Incidentally this all makes stims a very difficult combination for alcoholics and other GABA-loop drugs because the effects are synergistic and mask each other.) Obviously a difference in coatings should make zero difference but half the time there are broader problems with bioavailability or just generics being inferior quality in general, not just adderall but in general. The FDA isn't doing a good job with this really, just IMO, and not just with adderall. The entire foundation of generics rests on "this is chemically equivalent and absorbed the same" and it's clearly not for a lot of people and the generic is almost always the one that comes off worse. The entire product needs to be the same, binder and coating and all, with the same level of quality and in the case of stereochemistry it needs to be the same mixture. The bigger problem is just the shortages in general... my last 2 refills have both taken 7 days past the end of of the prescription, and this latest one I only managed to get 1/3 of my prescription filled (and they won't fill the rest of the prescription later if you pick it up, nor will they hold what they have while the rest of it comes in). Leftovers and reducing my dose (against the instructions of my doctor) will only carry you so far, I can't run 50% longer on a given prescription. The mood swings and stress and dopamine-balance/seeking problems that come with bouncing off it are rough too. My doctor's office is entirely unsympathetic and views their job as 24-48 hour turnarounds which is obviously completely insufficient for this kind of situation, no way it will be on the shelf in 48 hours. And if I push it then I come off drug-seeking (yes, voluntarily taking 1/3 of my prescription per month so I can get something at all, definitely drug-seeking). It sucks and I've become very disillusioned with my doctor over this, they just are not sympathetic at all. Everything to do with C2s is just so tainted by the adversarial relationship between the DEA and doctors and that only emphasizes the sometimes-adversarial relationship between doctor and patient. If this were lupus patients struggling to get their meds during the height of COVID mania, there would be no concern whatsoever about doing what was needed to get people their meds. There would be no concern about other generic providers just making more, either. But it being a C2 changes everything. It fucking sucks and it's disgusting this is how a health care system works.
bragadiru_mafia 4y ago
[flagged]
- SV_BubbleTime 4y ago
  You might be shocked to find out how many tech people are on them. I mean… it’s not exactly an unknown correlation.
  - shrimp_emoji 4y ago
    Coming from a culture where psychiatric medications are not normalized (because people simply couldn't afford them, if pharmacies even carried them), it is pretty disturbing how many people take some kind of pill. You can't help but feel as though so many people shouldn't have anything wrong with them such that they need pills -- i.e., mental illness should not exist at such high rates lol. (And, as subtext, should be feared and stigmatized.)
    - SV_BubbleTime 4y ago
      If you really want to be scared, wait until you find out how many people get hooked as little children.
    - api 4y ago
      How many people wear eyeglasses? Seems reasonable that a large percentage have suboptimal neurological issues that can be helped by a drug for the same reason so many have suboptimal vision: it doesn’t stop you from reproducing often enough to be selected out.
      - SV_BubbleTime 4y ago
        I don’t disagree with you. But… we can tell when eyes are messed up by verifiable flaws in the mechanisms, we can literally look in and see the issue. Not exactly so for brain meds. Is it the most fair comparison you can make?
faeriechangling 4y ago
Regarding generic equivalents - let me give a little history lesson: For Methylphenidate based medications, Ritalin, Ritalin LA, and Concerta all have the same active ingredient. However patients were willing to pay extra for Concerta due to it having the OROS delivery system which delivers the medication over an unusually long period of time of 12 hours in a very steady way. However in the US, the FDA allows medications which deliver within 80% to 125% of the same medication to qualify as a generic. A bunch of generics for concerta which did NOT use the OROS delivery method but instead used cheaper inferior methods which did not deliver medication as steadily or for as long were released simply because they were within that 80% to 125% window. In fact these generics were more similar to Ritalin LA than they were Concerta, so essentially the FDA allowed essentially a different drug to be substituted for Concerta when the ENTIRE POINT of Concerta for many patients was that it gave a longer lasting steadier dosage than Ritalin LA. If a patient didn't need this advantage, they could just take Ritalin LA instead. This was used as a pretence to deny insurance coverage for Concerta because a generic existed and caused many insured patients to pay thousands of dollars out of pocket for the real deal which they never saw again. These generics were scams which hurt patients quality of life and the medical system was complicit in hurting patients while financially benefiting these fraudsters since only having to pay for fake medicine instead of real medicine saved them money. Nobody besides patients were punished. This was well known and well documented within ADHD circles and after some years led to two generics being decertified. https://chadd.org/attention-article/exactly-like-brand/ https://chadd.org/attention-article/exactly-like-brand/ https://www.goodrx.com/concerta/certain-generics-are-no-longer-equivalent-to-brand-name-concerta https://www.goodrx.com/concerta/certain-generics-are-no-long... The problems with Concerta generics happened around the same time as the problems with Wellbutrin generics, problems which the FDA ALSO denied for years before backpedalling. The whole "generics are the same as the brand name" dogma is not actually true for all medications, and it's ADHD patients historically who were one of the groups of patients who found this out for themselves. So if people suspect there is a problem with their Adderall generics, I am VERY inclined to believe them, because we know that patients using similar drugs have shown extreme sensitivity to differences in generic equivalents in the past, and we know the FDA has approved "Generic equivalents" that were anything but repeatedly in the past. If you are getting ADHD medications, you can request your doctor write "no substitutions" and a specific brand on your prescription. If you are having coverage denied for either the brand name or the generic medication of the brand name (the exact same medication but with a different name and lower price, rather than being an equivalent) you CAN often get your doctor to help you lobby your insurer to get a specific brand covered by claiming medical need. >This means that, theoretically, obtaining a generic form of Adderall from a different manufacturer could alter how you feel while on the medication. However, the differences between generics are so small that an overwhelming majority of patients wouldn’t feel any change from their previous medication. “It’s not supposed to have drastic differences,” Dr. Dube said. What an absolutely fucking ignorant assertion given the history of ADHD patients being noted for their sensitivity to small differences between brand name medications and generic equivalents. What data did he use to come to the conclusion the "overwhelming majority" wouldn't feel any change and is he talking about the ADHD patient population or the general patient population? If he means the former he's wrong, if he means the latter he's being obtuse and misleading.
blincoln 4y ago
I don't think it's still manufactured, and maybe it's unrelated to this current situation, but around 8-15 years ago, one of the manufacturers of generic Adderall XR did something that made it much less effective. It was obvious which ones were theirs, because they were the only company that put theirs in blue capsules. Subjectively, it felt about half as effective as anyone else's. There were many, many forum discussions at the time from adults taking it as well as parents of kids who'd received it and noticed a big difference. It was especially frustrating because of all the rigamarole one has to deal with to get the medication in the first place. To not have it work and also have to wait another month to get one that does is ridiculous. I submitted a complaint to the FDA about it at the time. Never even got a form letter back. It's caused me to avoid generic drugs where possible ever since because if that can slip through, what else can? I assumed at the time it was some difference in the capsule itself or the delayed-released mechanism, as opposed to the active ingredients being different.
- kkielhofner 4y ago
  You see this with a lot of psychotropic medications (and likely others). It’s why when you fill a generic the label will specifically list the manufacturer. I’ve heard of at least a few instances with psych meds where people will either try to get a specific generic manufacturer or go back to name brand because of the significant impact due to variability you’re describing.
- drowsspa 4y ago
  I would also say that ADHD meds are much more susceptible to this, because the psychological effect is just so noticeable. Taking Vyvanse by itself compared with taking it with a little snack it makes quite a difference in the absorption for me; when I take it with Psyllium husk, then... EDIT: I guess I should expand on the effects of Psyllium. I mean the meds take longer to kick in
  - liketochill 4y ago
    Then what?
jebronie 4y ago
[flagged]
- sourcecodeplz 4y ago
  Don't be ignorant. There are many people living normal lives due to these medications whom would otherwise not be able to function. I do wonder though how did people deal with these problems in the past when neither ADHD or these drugs were recognized and available.
  - RankingMember 4y ago
    I suspect they just led more frustrating lives. I know mine was before I was finally diagnosed.
  - Shish2k 4y ago
    > I do wonder though how did people deal with these problems in the past Children get beaten for not sitting quietly, men who can’t hold down a job become homeless and die on the streets, women become dependent housewives and get beaten for preparing dinner wrong… The past was not a great time to have mental health conditions :P (The present isn’t great either, but at least we’re no longer burning people at the stake for being socially awkward)
  - californiadreem 4y ago
    >I do wonder though how did people deal with these problems in the past when neither ADHD or these drugs were recognized and available. I was diagnosed with ADHD as a child and again as an adult. I was medicated as a child and for part of my undergrad but intentionally haven't been medicated for more than fifteen years. I can give you my own personal picture of this situation. My understanding of my own now-sober psychology is that I will avoid anything that I don't have to do or don't actually care about (where these are contextually defined). While unmedicated, I focus on the things that I actually want to focus on, but the extent to which I can consciously control what those things are is largely out of my control. In this state, my conscious mind plays the LLM to what my body and unconscious mind are doing, namely my mental narrative is simply justifying and predicting what the next actions will be rather than determining what those actions actually are. When I was medicated, it was the exact opposite. My conscious mind was seemingly in control. Other inhibitory parts of my brain were turned off and I was able to consciously decide to do something, and then simply do it. In my personal experience though, the results of having "properly" functioning executive action were decidedly negative. The sober me that is in my body and doesn't require self-talk to actively maintain is content to be an economically unproductive, no-status nobody, merely exploring the world and taking care of my needs and those of my loved ones. The medicated "me" was nothing but conscious ambition, made poor long-term decisions, and created novel stressors with high cognitive loads that required constant medication and self-talk to maintain. I realized that I identified more with the sober me than the medicated me and accordingly stopped taking stimulants. To draw on all this to answer your question, I think that in the absence of habitual stimulant use and being surrounded by the "achievements" of those that are habitual stimulant users, the majority of people wouldn't know of or have "these problems" but simply lead uneventful, low stress lives, following their very bodily-determined whims and fancies. Sure, there'd be fewer Paul Erdőses ("You've showed me I'm not an addict. But I didn't get any work done. I'd get up in the morning and stare at a blank piece of paper. I'd have no ideas, just like an ordinary person. You've set mathematics back a month.") churning out theorems, but equally, there'd be fewer Hitlers (See: Blitzed: Drugs in Nazi Germany), SBFs ("I think they are things that, on the margins, helped me focus a little bit. I wish I had been a lot more focused over the last year."), or Caroline Ellisons ("[N]othing like regular amphetamine use to make you appreciate how dumb a lot of normal, non-medicated human experience is").
taylorportman 4y ago
I know this is overly tangential, sorry.. there are xr mechanisms with varying degrees of linearity, molecular 'handednesses', and recently I wanted to try these eye drops to replace reading glasses and stumbled onto this fractional dosage relationship. The last defined a medication's application - that generics vs expensive effects depend on customized level of active components that can produce a completely different drug. The point being that the discount of bulk medication and fine tuning make for the expense and it is still a compromise. The epiphany for me was those eye drops for reading would be so cheap if I could get it in bulk maximal strength and dilute to arrive at a specific concentration that changed a drug already used for completely unrelated (dry mouth or something) purposes at a slight difference in concentration apparently changes the fluid level in the eyes enough to compensate for age. I recalled all of the times a helpful pharmacist would change other types of prescriptions to avoid the expense of brand label fractional doses letting the patient substitute a common bulk variety and a pill cutter which becomes more difficult with fine granularity - this active ingredient/filler ratio for pills. So I began to wonder what do they do when manufacturing processes produce more desirable chiralities - what happens to the remainder? If there is some conspiracy it is probably related to manufacturing processes, bulk availability, and/or capacity for a pharmacy to behave like a custom apothecary, all of the liability that that would entail.. thus the expense of name brand pharmaceuticals?
trafficante 4y ago
As somebody approaching 40 who has been on ADHD meds most of his adult life and for portions of his childhood: It’s not that (generic) Adderall is different so much as there seems to have been an explosion of generic manufacturers all using wildly different amounts of the actual amphetamine salts and binding agents. For me personally, the Mallinckrodt generic seems to use a different binding agent that causes bloating and occasional headaches. The shortage has really demonstrated just how differently these generics are formulated. Eg: I used to take Sandoz 20mg tablets that were about the size of two baby aspirins. At one point, a few months back, I was forced to modify my prescription so it could be filled as 10mg tablets. My new 10mg bottle was filled with Teva manufactured pills that each were roughly the size of 2.5 of my old Sandoz 20mgs - despite being half the dosage. That’s a ton of filler. The worst part about the shortage - beyond the anxious pharmacy hunt each month - is that my insurance pushed a new shortage policy that places a moratorium on modifying ADHD prescriptions. I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil.
- nibbleshifter 4y ago
  > I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil. Grey market moda is easy to find. I've been taking a small dose of moda along with my current meds, and it works out.
  - trafficante 4y ago
    Interesting. I’ll have to look into it, thank you.
  - mkoryak 4y ago
    Can you recommend a place you've used in the past? Using the first result from search seems like a bad idea
    - fire 4y ago
      idk maybe reddit's nootropics subreddit
2OEH8eoCRo0 4y ago
[flagged]
- favaq 4y ago
  Precisely what I was thinking. This kind of hoax sounds like it could easily spread among crazy people.
- RankingMember 4y ago
  a "bunch of psychotics"?
cs2818 4y ago
Anecdotal, but the generic (Alvogen) I've received the past few times for the IR version has felt much stronger and has ultimately led to me adjusting to about half my prescribed dose. I've taken the same dose produced by many different manufacturers for ~10 years and this is the first time I have noticed such a big difference. So far I haven't been able to find any other confounding factor that would account for the change in effect.
- Eduard 4y ago
  Maybe your batch got all the killer, the others filler.
gtop3 4y ago
Are there any concerns that the reduction in prescription stimulant supply/quality will cause some individuals to substitute their prescription medication for illicit methamphetamine or cocaine?
- LoveMortuus 4y ago
  I would say yes. Legal status of stuff doesn't really affect the demand, it just affects the regulation or should I say, if it's illegal it's not regulated. If someone wants weed or mushrooms they'll find a way to get them regardless of their legal status. Although it's been many years, I do speak from experience.
- PragmaticPulp 4y ago
  Recreational stimulants medications don't substitute for ADHD medications. You can always find anecdotes from people who think they're going to use some street drug as a substitute for ADHD medication, but it always ends poorly. Proper ADHD treatment requires stable dosing. It's impossible to dose street drugs accurately due to the varying quality and different "cuts". Even with precise measuring, a person could end up dosing twice as much from one batch to the next. I browse recreational drug forums occasionally to see what people are doing these days. Even the recreational drug users on Reddit will readily admit that trying to use research chemicals or street drugs for therapeutic purposes is a dead end. It just results in abuse-style patterns as people chase the high and subsequently crash. If people are really struggling, the real solution is to try methylphenidate or the various non-stimulant ADHD options. The non-stimulant options aren't as "fun" and can take a few weeks to kick in, but they beat the stimulants for a lot of people who have the foresight to try them and stick with it. They also seem to be much less prone to tolerance over time.
- pcthrowaway 4y ago
  I'm literally trying to figure out how to do this safely right now. I have a person I can get it from, it's decriminalized where I live, and there are abundant facilities for detailed testing so I can get a sense of what the purity is. Just wondering about dose and how this could work. I'm ADHD and it's been impacting me a lot recently
Reptur 4y ago
This is 100% happening, we need these pills tested in a lab. My bet is they are likely thinning it because the demand is too high. The DEA will not approve the new limits because of "The War on Drugs" is being revived. I was switched to Teva at same dose this past month because of the shortage and it does not work at all. Its very frustrating, like getting your wheel chair and realizing it doesn't have wheels.
- Shank 4y ago
  The Teva generic or the Teva brand name? They make both a generic and a brand-name. Everyone I've heard swears by the Teva non-generic as "the best" for just adderall.
  - Reptur 4y ago
    generic adderall
DontchaKnowit 4y ago
Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects. There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite. I take this drug daily. The current supply crunch has meant I've had to take inferior versions of the product for nearly a year now. It fucking sucks. I need it to work but the side effects often mean little sleep, strange repetitive behaviour, absurd hypersexuality, etc. Its a travesty, not in the best interest of the consumer. If you are on this medication you are treated like dog shit from the doctor to the insurance company to the pharmacy to the pill itself. All in the name of either preventi g addicts from getting it (who cares?) Or making more money for some massive company.
- robotastronaut 4y ago
  Man, this helps me understand so much of what I’m experiencing. I had to switch to cheap stuff about two months ago and I’ve been all over the place. Absolutely terrible sleep, too.
- refurb 4y ago
  There is no regulation for the % of each isomer in the product. Do you have a source? The FDA label says it's 50% d,l-amphetamine (50/50) plus 50% d-amphetmaine, so you end up with a 3:1 ratio of dextroamphetamine to levoamphetamine. Why would a manufacturer do more work to change the 50/50 mix? And why would it vary from batch to batch? The FDA has requirements on manufacturing that each lot is made to the same specifications. The more reasonable explanation is that the binding agents changed, which may change the rate at which the drug dissolves and is absorbed. This actually happened a while back with generic bupropion. Generic manufacturers made a 300 mg version, which had 300 mg of drug in it. However, the medicine was absorbed much more quickly leading to a rash of side effect complaints from patients. The FDA eventually recalled the drug. If you want to read how generics are tested and approved, Derek Lowe did a nice blog post on it: https://www.science.org/content/blog-post/generic-wellbutrin-problem-whose-fault-it https://www.science.org/content/blog-post/generic-wellbutrin... "In that study, the results of which became available in August 2012, Budeprion XL 300 mg failed to demonstrate bioequivalence to Wellbutrin XL 300 mg."
LoganDark 4y ago
Some of these "differences" can be life-threatening. I'm on 30mg of generic dextroamphetamine sulfate XR per day. It evaporates my ADHD entirely, makes me feel much more comfortable and relaxed, and makes it easier to regulate emotions and stress. As a bonus it also helps me feel my emotions more readily, which I consider amazing. But last time, the brand of generic that my pharmacy gave me was Actavis (owned by, guess who, Teva) instead of the Mallinckrodt that I got the first time. When it first kicked in, I was in the middle of relaxing in bed and my heart just suddenly went completely insane out of nowhere. My heart rate was around 130bpm and I could not sleep at all anymore, even with generous amounts of melatonin 4+ hours before bed. My blood pressure was 180 over 130 for two days straight. I eventually realized what the problem was and switched back to Mallinckrodt. My heart rate was soon okay and I could relax and sleep again, but it took around 4–5 days for my blood pressure to return to safe levels, probably because of all the bodily load that those Actavis capsules caused. At my doctor's appointment yesterday, I had my doctor explicitly forbid Actavis and then put "brand medically necessary" on my latest prescription three times, once in handwriting, requiring Mallinckrodt specifically. Hopefully I will not get the wrong meds again. AFAICT, the main reason it was so dangerous is probably because I am taking 30mg daily. But either my ADHD is really that bad or I started off with a very high tolerance, because my tolerance was discovered from having to take 20mg of adderall IR for it to do anything at all. And that just so happened to be terrible badness, so I switched to pure dextroamphetamine which seems to work wonderfully. But only this very specific capsule from this very specific brand. The others might literally cause me a heart attack.
- TechBro8615 4y ago
  I am on a similar script, and I think the half life on these pills is way longer than commonly advertised. The primary effects last 4-6 hours, sure, but the actual half life is more like 12 hours. I will absolutely not be sleeping within 4 hours of taking 15mg of dexamphetamine. Wikipedia also seems to confirm this (duration of effect vs. elimination half-life) [0]. The implication of that is that if you take the same amount every day you can build up a wall of toxicity. I recommend skipping your dose on the weekend, or cutting it significantly and only taking it in the morning. I find this helps me keep the effects feeling more even over time. Also, maybe I should start drinking a glass of orange juice a few hours before bed to try to accelerate the excretion. [0] https://en.wikipedia.org/wiki/Dextroamphetamine https://en.wikipedia.org/wiki/Dextroamphetamine
henearkr 4y ago
Or, maybe an increasing number of people have suffered from brain fog caused by long covid, and that would make them feel like their Adderall is not working?
- DontchaKnowit 4y ago
  Nope. Line up 4 different brands of amphetamine salts and try them on different days. You will find that some make you feel geeked and strung out. Some make you feel calm and focused.
  - henearkr 4y ago
    Good point.
bosch_mind 4y ago
Is it still the case that many folks can’t pick up their script at all independent of the manufacturer? Curious how long the wait is
frogger8 4y ago
Noticed this as well. Now I can’t find that generic in stock either. As an alternative, I would like to know what THC / medical Marijuna product is the best alternative to out of stock Adderall. I will take my answer off air. Click
trashface 4y ago
The near future: you pay full price for a drug, your insurance pays full price, and you get a watered down or fake med.
lazystar 4y ago
I'm considering going back to smokeless tobacco because of this sitution. For 400 years, the majority of the population used tobacco/nicotine for increased concentration. Over the last 30 years, that rate has declined, while at the same time, ADHD diagnoses have increased. Studies have shown nicotine is effective in reducing ADHD symptoms, so it seems that society's elimination of nicotine has revealed that it was covering up ADHD for all those years.
ofchnofc 4y ago
This thread is FASCINATING to read -- My brand of Adderall changed recently. I even more recently decided to try going off of it. I miss it. Somewhere here wrote that it helped them be in touch with their emotions. I can give up the focus, I can give up the productivity, I can give up the impulse control. But losing the fast instinct to stick up for myself, ask for what I want, express my needs before they overwhelm me... ... it's a bummer to think that Adderall really was helping me and that it wasn't simply a matter of fixing my depression/perspective.
rastamutta 4y ago
[flagged]
pmoriarty 4y ago
Do these amphetamines make people more talkative? I recently met someone who says they take Vyvanse for ADHD and they just can not shut up, and constantly butt in on conversations to tell everyone about themselves. I didn't know this person before they started taking these meds, but I suspect these meds might be a contributing factor to that behavior. Could that be so?
- dasv 4y ago
  That is the ADHD. Constantly changing the topic to talk about something that happened to you once which you were just reminded of because of a detail in the conversation. Too much sharing of personal details with people I maybe just met. Telling too much to someone in spite of knowing that I should have shut up. It has taken me ages to be fully aware that I do it, and when I notice I try to stop myself from derailing the topic being discussed. If I feel that it is truly relevant I cross my fingers or something like that to add it at the end of the conversation, but usually after a few seconds it loses the urgency and I feel I can drop it, or even forgetting what I wanted to add at that point. It is absolutely a social problem and I know people see it as a flaw of character, but it is slowly getting better. Being gently reminded that I am doing it helps because sometimes you just don't notice. Of course if your acquaintance is on a too high dose of Vyvanse or has been wrongly diagnosed it can cause a bad case of motormouth, as all stimulants do...
t0bia_s 4y ago
I wonder why we in modern west medicine focus so much to extinguish the consequences but ignore causes of illness. Would it ruin business for pharma companies?
- samtho 4y ago
  This is an unhelpful and incorrect sentiment in the context of ADHD medication. The cause has been linked primarily to genetics as ADHD in particular is caused by the brain not producing enough dopamine (or cleaning it up too quickly) to function well in our society. It is also not endemic of modern times as there is evidence that ADHD has been with the human race since it existed. Stimulant type drugs are some of the most effective drugs we have to treat the conditions they target, because it counteracts precisely the mechanism (dopamine production/retention) that is deficient in ADHD brains.
  - t0bia_s 4y ago
    Ah... Genetics. Sure. What about level of sugar that we consume almost in everything? Are there ADHD diagnosis in... Africa?
    - samtho 4y ago
      Diet has been strongly linked to mood, focus, and sleep. Consequently, the hormones Dopamine, Serotonin, Epinephrine, and Norepinephrine all have receptors in the brain as well as the gut and this should not be too surprising because consuming calories, vitamins, and water is fundamental to survival. In fact your gut has 100 million neurons in it, more than a dogs brain. While it’s not “thinking” in the way we know as consciousness, it does make decisions and pull levers to motivate you to do stuff. It should come as no surprise that dumping refined sugar into this system, something we did not evolve to process in its current form, will cause issues. ADHD is a sort of misnomer, it doesn’t describe a deficit of attention but rather intention. It messes with the wiring of your prefrontal cortex to limit the effectiveness of executive functioning which handicaps your ability to make decisions based on importance (because everything seems just as important) and the brain makes it very unpleasant to start tasks that non stimulating (to the point of withholding dopamine and dumping cortisol into the bloodstream). There is plenty of ADHD in Africa but you need to find it in the places where non-ADHD brains are rewarded. I suspect that as African nations become more metropolitan and the workforce demands shift to meeting the needs of a city, we will see even more ADHD diagnosis in this part of the world.
jshaqaw 4y ago
What alternative medications are people finding effective and smooth transitions for real ADHD users who can’t deal with this instability anymore?

262 points by gnicholas 4y ago

I'm glad there's no obvious shortage in Canada, this stuff has a tendency to spill over from America. I finally I was to get prescribed and it definitely works for me. 20mg of Sandoz XR, it's like magic.

briHass 4y ago
You may have just gotten lucky. It seems like the situation in the US is highly location/pharmacy-specific. The other variables are type (IR/XR, generic/non, etc.) and unit dosage. The worst hit seem to be 10mg/20mg generic IR Adderall, because that is usually the most popular and cheapest option. Switching to XR or to a less-common unit size (like 25mg) may increase the odds of finding it somewhere. It really is a super frustrating situation. Because of the tight controls on the drug, prescriptions are almost always sent electronically from provider to pharmacy, and any changes or transfers must go through the provider. Most providers aren't going to play whack-a-mole by continuing to transfer the script, and as the article implies, changing medication type (Ritalin/Adderall/Vyvanse) or IR/XR can have significant impact on the effectiveness and potential side-effects. Responsible providers aren't just going to flip/flop medications without at least a consultation.
- BizarreByte 4y ago
  >Because of the tight controls on the drug, prescriptions are almost always sent electronically from provider to pharmacy, and any changes or transfers must go through the provider. Very different from where I live in Canada. I just get a written script and can take it wherever I like. The pharmacy submits the info to the provincial drug tracking program to make sure it's all kosher and when it is I'm on my way. If a pharmacy every refused to fill it I could just take the script elsewhere.
- vogt 4y ago
  >It seems like the situation in the US is highly location/pharmacy-specific. Anecdotally, this definitely rings true. I recently moved from Dallas-Fort Worth to a VERY rural part of west Texas (population >2000). The only pharmacy within an hours drive, which is 30 minutes away in a town of ~20,000 has filled my prescription regularly. Back in DFW I know of three different people who have been unable to get their Adderall filled for months. And there's a pharmacy practically on every corner out there.
thomastjeffery 4y ago
The shortage is entirely arbitrary, and only exists in the US. We had a significant increase in ADHD diagnosis during the pandemic, because telehealth is much more approachable for people with untreated ADHD. Despite that increase, the DEA refused to increase the arbitrary limit for how much Adderall can be manufactured in the US. So we have an entirely avoidable shortage on our hands.
- trafficante 4y ago
  > We had a significant increase in ADHD diagnosis during the pandemic, because telehealth is much more approachable for people with untreated ADHD. And, in typical fashion, the DEA responds to the problem in nearly the worst way possible: they announced new regulations to stop telehealth providers from writing new prescriptions for ADHD meds. I suppose this keeps the shortage from getting worse, but that’s about it.
  - dragonwriter 4y ago
    They aren’t new regulations, its the ending of the temporary suspension of the old regulations which was premised on the pandemic state of emergency, which has ended. Its bad because the pre-existing rules were bad and should have been changed instead of merely suspended based on the pandemic.

philwelch 4y ago

https://archive.ph/LIlpt https://archive.ph/LIlpt

analyte123 4y ago

Kind of bizarre that the author won’t entertain the most obvious explanation given the documented problems with many generic drugs [1]. I guess the difference in this case is that the patients can tell right away. [1] https://www.npr.org/sections/health-shots/2019/05/12/722216512/bottle-of-lies-exposes-the-dark-side-of-the-generic-drug-boom https://www.npr.org/sections/health-shots/2019/05/12/7222165...

Waterluvian 4y ago
The difference in Concerta and its generic is chocolate and vanilla to me. The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours. Completely unsurprised if an Adderall generic had just as significant impacts.
- luckydata 4y ago
  the generic concerta all have a KNOWN issue with manufacturing. The slow release mechanism is mechanic, not chemical, and only ONE generic is manufactured the right way. https://www.goodrx.com/concerta/certain-generics-are-no-longer-equivalent-to-brand-name-concerta https://www.goodrx.com/concerta/certain-generics-are-no-long...
  - joezydeco 4y ago
    It's literally a plastic capsule with microscopic holes drilled in it. A sponge on one end absorbs moisture and swells at a fixed rate, slowly pushing the methylphenidate out the other side.
- deleted 4y ago
  [deleted]
- RyJones 4y ago
  That is exactly my experience. The brand-name Concerta is a smooth push all day, the generic is terrible.
- 4y ago

mtlmtlmtlmtl 4y ago

[flagged]

philwelch 4y ago
Hush! Shh! Don't tell them! The adderall shortage is the result of a completely artificial quota set by the DEA. Those of us who use dexedrine have been mostly spared, but if the adderall users switch to dexedrine, we might start having issues.
- WalterSear 4y ago
  I had to go with amphetamine because dexedrine was unavailable in my area.
- thomastjeffery 4y ago
  Considering that the Adderall shortage has affected my pharmacy's supply of Concerta, you are probably just relatively lucky.
waboremo 4y ago
Adderall contains dextroamphetamine btw
- mtlmtlmtlmtl 4y ago
  I know this. But it also contains levoamphetamine. But as far as I know there's no clinically proven benefit(happy to be proven wrong) to including levoamph, and it can cause more side effects. Which is why in most countries these days adderall is not really prescribed, and often isn't even in the pharmacopoeia. Why adderall is still in use in the US is an interesting question I don't have the answer to.
  - loeg 4y ago
    > But as far as I know there's no clinically proven benefit My impression of US pharma regulation and drug trials is that it would not have been approved if it did not show some benefit over the status quo. I don't know about adderall's clinical trials in particular, though.

therein 4y ago

I wouldn't be surprised if they are doing this. It should be relatively easy to test, though. I know many people that'd volunteer do run NMR or mass spec.

awinter-py 4y ago
interesting -- where? guessing it would be easy to collect a bunch of different brands + generics to compare
- therein 4y ago
  Pretty much anyone with friends who study chemistry would do. The problem is, no matter what you do, it is going to be very challenging proving the chain of custody to hold them accountable.
  - awinter-py 4y ago
    point taken but also shrug -- if the machine turns up a pattern, you get it redone at a real lab

awinter-py 4y ago

the stuff in here about 'minor differences in coating could make a difference but shouldn't' is surprisingly badly researched both teva + shire manufacture a branded and a generic -- just ask them what the difference is between the two, right? and if they hang up you can write, 'both teva and shire refused to say if their generic works' I'm fairly sure this is Shire's original patent for XR beads https://patents.google.com/patent/US6322819B1/ https://patents.google.com/patent/US6322819B1/ they have a subsequent patent for a more continuous delivery system https://patents.google.com/patent/US6913768B2/ https://patents.google.com/patent/US6913768B2/ (from plasma concentration, the double-pulsed one looks as smooth as continuous delivery, but I'm guessing the brain + blood half lives are different) but the bead material is probably FDA scrutinized, and any chemical difference between the branded + generic version is in theory public knowledge; shocking nyt didn't like, call a chem lab or something before hitting send on this one the author speculating that someone is complaining about switching from an immediate release to an XR also feels bogus -- presumably I would say in my tiktok that it's a capsule instead of a tablet?

hooverd 4y ago
That's like baby's first chemistry lab lesson, inactive ingredients can make a big difference sometimes.
- aksss 4y ago
  “Inactive ingredient” is a term with similar provenance as “junk dna”, “oldest human tool-making”, and “oldest humans in North America”. These terms represent a state of current understanding more than absolute truth.
jws 4y ago
I suppose things might have changed in ~half a century, the FDA used to care about everything. Back in the late '80s the VAX-11/750 that was part of the Siemens MRI scanners was shipped in the old blue trim color long after DEC had switched to the very chic "brown on tan" color scheme. The FDA approval for the scanner would not let them change the color of the paint because of some bleedover of medication regulation language into the equipment approval regulations.

_pwzj 4y ago

Not a doctor, just a patient: Adderall is a mixed salt, it's two stereoisomers, amphetamine and dextroamphetamine. One of them (I think it's the amphetamine) is "speedier" feeling and the other one (I think dex) is "cleaner". Dextroamphetamine is also available as a purified salt itself, as dexedrine. And I think that's more of a "kids medicine" specifically because it's less "speedy". I think there's nothing that guarantees any particular ratio comes in the product, and obviously generics have very mixed results on just how "bioequivalent" it really ends up being. I think the mixture is varying and people end up feeling like it's different because they're feeling the "speediness" change and that's the feeling they associate with being medicated with stimulants. Amphetamines are another dopamine-releasing and gaba-ergenic family of drugs and my suspicion is that in the presence of an opioid antagonist like naltrexone probably patients would not be able to distinguish between the exact mixtures of the stereoisomers but without it they probably can tell which feels "speedier" and the perception is that is how much their symptoms being treated. The dopamine-releasing loop probably is a not-insignificant part of how it treats ADHD though, dopamine-seeking is a key aspect of ADHD (do you drink caffeine or eat sugar before you go to bed, or when you wake up in the middle of the night, and then fall right asleep? that's because your brain is getting dopamine satiation finally). (Incidentally this all makes stims a very difficult combination for alcoholics and other GABA-loop drugs because the effects are synergistic and mask each other.) Obviously a difference in coatings should make zero difference but half the time there are broader problems with bioavailability or just generics being inferior quality in general, not just adderall but in general. The FDA isn't doing a good job with this really, just IMO, and not just with adderall. The entire foundation of generics rests on "this is chemically equivalent and absorbed the same" and it's clearly not for a lot of people and the generic is almost always the one that comes off worse. The entire product needs to be the same, binder and coating and all, with the same level of quality and in the case of stereochemistry it needs to be the same mixture. The bigger problem is just the shortages in general... my last 2 refills have both taken 7 days past the end of of the prescription, and this latest one I only managed to get 1/3 of my prescription filled (and they won't fill the rest of the prescription later if you pick it up, nor will they hold what they have while the rest of it comes in). Leftovers and reducing my dose (against the instructions of my doctor) will only carry you so far, I can't run 50% longer on a given prescription. The mood swings and stress and dopamine-balance/seeking problems that come with bouncing off it are rough too. My doctor's office is entirely unsympathetic and views their job as 24-48 hour turnarounds which is obviously completely insufficient for this kind of situation, no way it will be on the shelf in 48 hours. And if I push it then I come off drug-seeking (yes, voluntarily taking 1/3 of my prescription per month so I can get something at all, definitely drug-seeking). It sucks and I've become very disillusioned with my doctor over this, they just are not sympathetic at all. Everything to do with C2s is just so tainted by the adversarial relationship between the DEA and doctors and that only emphasizes the sometimes-adversarial relationship between doctor and patient. If this were lupus patients struggling to get their meds during the height of COVID mania, there would be no concern whatsoever about doing what was needed to get people their meds. There would be no concern about other generic providers just making more, either. But it being a C2 changes everything. It fucking sucks and it's disgusting this is how a health care system works.

bragadiru_mafia 4y ago

[flagged]

SV_BubbleTime 4y ago
You might be shocked to find out how many tech people are on them. I mean… it’s not exactly an unknown correlation.
- shrimp_emoji 4y ago
  Coming from a culture where psychiatric medications are not normalized (because people simply couldn't afford them, if pharmacies even carried them), it is pretty disturbing how many people take some kind of pill. You can't help but feel as though so many people shouldn't have anything wrong with them such that they need pills -- i.e., mental illness should not exist at such high rates lol. (And, as subtext, should be feared and stigmatized.)
  - SV_BubbleTime 4y ago
    If you really want to be scared, wait until you find out how many people get hooked as little children.
  - api 4y ago
    How many people wear eyeglasses? Seems reasonable that a large percentage have suboptimal neurological issues that can be helped by a drug for the same reason so many have suboptimal vision: it doesn’t stop you from reproducing often enough to be selected out.
    - SV_BubbleTime 4y ago
      I don’t disagree with you. But… we can tell when eyes are messed up by verifiable flaws in the mechanisms, we can literally look in and see the issue. Not exactly so for brain meds. Is it the most fair comparison you can make?

faeriechangling 4y ago

Regarding generic equivalents - let me give a little history lesson: For Methylphenidate based medications, Ritalin, Ritalin LA, and Concerta all have the same active ingredient. However patients were willing to pay extra for Concerta due to it having the OROS delivery system which delivers the medication over an unusually long period of time of 12 hours in a very steady way. However in the US, the FDA allows medications which deliver within 80% to 125% of the same medication to qualify as a generic. A bunch of generics for concerta which did NOT use the OROS delivery method but instead used cheaper inferior methods which did not deliver medication as steadily or for as long were released simply because they were within that 80% to 125% window. In fact these generics were more similar to Ritalin LA than they were Concerta, so essentially the FDA allowed essentially a different drug to be substituted for Concerta when the ENTIRE POINT of Concerta for many patients was that it gave a longer lasting steadier dosage than Ritalin LA. If a patient didn't need this advantage, they could just take Ritalin LA instead. This was used as a pretence to deny insurance coverage for Concerta because a generic existed and caused many insured patients to pay thousands of dollars out of pocket for the real deal which they never saw again. These generics were scams which hurt patients quality of life and the medical system was complicit in hurting patients while financially benefiting these fraudsters since only having to pay for fake medicine instead of real medicine saved them money. Nobody besides patients were punished. This was well known and well documented within ADHD circles and after some years led to two generics being decertified. https://chadd.org/attention-article/exactly-like-brand/ https://chadd.org/attention-article/exactly-like-brand/ https://www.goodrx.com/concerta/certain-generics-are-no-longer-equivalent-to-brand-name-concerta https://www.goodrx.com/concerta/certain-generics-are-no-long... The problems with Concerta generics happened around the same time as the problems with Wellbutrin generics, problems which the FDA ALSO denied for years before backpedalling. The whole "generics are the same as the brand name" dogma is not actually true for all medications, and it's ADHD patients historically who were one of the groups of patients who found this out for themselves. So if people suspect there is a problem with their Adderall generics, I am VERY inclined to believe them, because we know that patients using similar drugs have shown extreme sensitivity to differences in generic equivalents in the past, and we know the FDA has approved "Generic equivalents" that were anything but repeatedly in the past. If you are getting ADHD medications, you can request your doctor write "no substitutions" and a specific brand on your prescription. If you are having coverage denied for either the brand name or the generic medication of the brand name (the exact same medication but with a different name and lower price, rather than being an equivalent) you CAN often get your doctor to help you lobby your insurer to get a specific brand covered by claiming medical need. >This means that, theoretically, obtaining a generic form of Adderall from a different manufacturer could alter how you feel while on the medication. However, the differences between generics are so small that an overwhelming majority of patients wouldn’t feel any change from their previous medication. “It’s not supposed to have drastic differences,” Dr. Dube said. What an absolutely fucking ignorant assertion given the history of ADHD patients being noted for their sensitivity to small differences between brand name medications and generic equivalents. What data did he use to come to the conclusion the "overwhelming majority" wouldn't feel any change and is he talking about the ADHD patient population or the general patient population? If he means the former he's wrong, if he means the latter he's being obtuse and misleading.

blincoln 4y ago

I don't think it's still manufactured, and maybe it's unrelated to this current situation, but around 8-15 years ago, one of the manufacturers of generic Adderall XR did something that made it much less effective. It was obvious which ones were theirs, because they were the only company that put theirs in blue capsules. Subjectively, it felt about half as effective as anyone else's. There were many, many forum discussions at the time from adults taking it as well as parents of kids who'd received it and noticed a big difference. It was especially frustrating because of all the rigamarole one has to deal with to get the medication in the first place. To not have it work and also have to wait another month to get one that does is ridiculous. I submitted a complaint to the FDA about it at the time. Never even got a form letter back. It's caused me to avoid generic drugs where possible ever since because if that can slip through, what else can? I assumed at the time it was some difference in the capsule itself or the delayed-released mechanism, as opposed to the active ingredients being different.

kkielhofner 4y ago
You see this with a lot of psychotropic medications (and likely others). It’s why when you fill a generic the label will specifically list the manufacturer. I’ve heard of at least a few instances with psych meds where people will either try to get a specific generic manufacturer or go back to name brand because of the significant impact due to variability you’re describing.
drowsspa 4y ago
I would also say that ADHD meds are much more susceptible to this, because the psychological effect is just so noticeable. Taking Vyvanse by itself compared with taking it with a little snack it makes quite a difference in the absorption for me; when I take it with Psyllium husk, then... EDIT: I guess I should expand on the effects of Psyllium. I mean the meds take longer to kick in
- liketochill 4y ago
  Then what?

jebronie 4y ago

[flagged]

sourcecodeplz 4y ago
Don't be ignorant. There are many people living normal lives due to these medications whom would otherwise not be able to function. I do wonder though how did people deal with these problems in the past when neither ADHD or these drugs were recognized and available.
- RankingMember 4y ago
  I suspect they just led more frustrating lives. I know mine was before I was finally diagnosed.
- Shish2k 4y ago
  > I do wonder though how did people deal with these problems in the past Children get beaten for not sitting quietly, men who can’t hold down a job become homeless and die on the streets, women become dependent housewives and get beaten for preparing dinner wrong… The past was not a great time to have mental health conditions :P (The present isn’t great either, but at least we’re no longer burning people at the stake for being socially awkward)
- californiadreem 4y ago
  >I do wonder though how did people deal with these problems in the past when neither ADHD or these drugs were recognized and available. I was diagnosed with ADHD as a child and again as an adult. I was medicated as a child and for part of my undergrad but intentionally haven't been medicated for more than fifteen years. I can give you my own personal picture of this situation. My understanding of my own now-sober psychology is that I will avoid anything that I don't have to do or don't actually care about (where these are contextually defined). While unmedicated, I focus on the things that I actually want to focus on, but the extent to which I can consciously control what those things are is largely out of my control. In this state, my conscious mind plays the LLM to what my body and unconscious mind are doing, namely my mental narrative is simply justifying and predicting what the next actions will be rather than determining what those actions actually are. When I was medicated, it was the exact opposite. My conscious mind was seemingly in control. Other inhibitory parts of my brain were turned off and I was able to consciously decide to do something, and then simply do it. In my personal experience though, the results of having "properly" functioning executive action were decidedly negative. The sober me that is in my body and doesn't require self-talk to actively maintain is content to be an economically unproductive, no-status nobody, merely exploring the world and taking care of my needs and those of my loved ones. The medicated "me" was nothing but conscious ambition, made poor long-term decisions, and created novel stressors with high cognitive loads that required constant medication and self-talk to maintain. I realized that I identified more with the sober me than the medicated me and accordingly stopped taking stimulants. To draw on all this to answer your question, I think that in the absence of habitual stimulant use and being surrounded by the "achievements" of those that are habitual stimulant users, the majority of people wouldn't know of or have "these problems" but simply lead uneventful, low stress lives, following their very bodily-determined whims and fancies. Sure, there'd be fewer Paul Erdőses ("You've showed me I'm not an addict. But I didn't get any work done. I'd get up in the morning and stare at a blank piece of paper. I'd have no ideas, just like an ordinary person. You've set mathematics back a month.") churning out theorems, but equally, there'd be fewer Hitlers (See: Blitzed: Drugs in Nazi Germany), SBFs ("I think they are things that, on the margins, helped me focus a little bit. I wish I had been a lot more focused over the last year."), or Caroline Ellisons ("[N]othing like regular amphetamine use to make you appreciate how dumb a lot of normal, non-medicated human experience is").

taylorportman 4y ago

I know this is overly tangential, sorry.. there are xr mechanisms with varying degrees of linearity, molecular 'handednesses', and recently I wanted to try these eye drops to replace reading glasses and stumbled onto this fractional dosage relationship. The last defined a medication's application - that generics vs expensive effects depend on customized level of active components that can produce a completely different drug. The point being that the discount of bulk medication and fine tuning make for the expense and it is still a compromise. The epiphany for me was those eye drops for reading would be so cheap if I could get it in bulk maximal strength and dilute to arrive at a specific concentration that changed a drug already used for completely unrelated (dry mouth or something) purposes at a slight difference in concentration apparently changes the fluid level in the eyes enough to compensate for age. I recalled all of the times a helpful pharmacist would change other types of prescriptions to avoid the expense of brand label fractional doses letting the patient substitute a common bulk variety and a pill cutter which becomes more difficult with fine granularity - this active ingredient/filler ratio for pills. So I began to wonder what do they do when manufacturing processes produce more desirable chiralities - what happens to the remainder? If there is some conspiracy it is probably related to manufacturing processes, bulk availability, and/or capacity for a pharmacy to behave like a custom apothecary, all of the liability that that would entail.. thus the expense of name brand pharmaceuticals?

trafficante 4y ago

As somebody approaching 40 who has been on ADHD meds most of his adult life and for portions of his childhood: It’s not that (generic) Adderall is different so much as there seems to have been an explosion of generic manufacturers all using wildly different amounts of the actual amphetamine salts and binding agents. For me personally, the Mallinckrodt generic seems to use a different binding agent that causes bloating and occasional headaches. The shortage has really demonstrated just how differently these generics are formulated. Eg: I used to take Sandoz 20mg tablets that were about the size of two baby aspirins. At one point, a few months back, I was forced to modify my prescription so it could be filled as 10mg tablets. My new 10mg bottle was filled with Teva manufactured pills that each were roughly the size of 2.5 of my old Sandoz 20mgs - despite being half the dosage. That’s a ton of filler. The worst part about the shortage - beyond the anxious pharmacy hunt each month - is that my insurance pushed a new shortage policy that places a moratorium on modifying ADHD prescriptions. I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil.

nibbleshifter 4y ago
> I literally am not allowed to try “creative” solutions like Dexedrine or even something like modafanil. Grey market moda is easy to find. I've been taking a small dose of moda along with my current meds, and it works out.
- trafficante 4y ago
  Interesting. I’ll have to look into it, thank you.
- mkoryak 4y ago
  Can you recommend a place you've used in the past? Using the first result from search seems like a bad idea
  - fire 4y ago
    idk maybe reddit's nootropics subreddit

2OEH8eoCRo0 4y ago

[flagged]

favaq 4y ago
Precisely what I was thinking. This kind of hoax sounds like it could easily spread among crazy people.
RankingMember 4y ago
a "bunch of psychotics"?

cs2818 4y ago

Anecdotal, but the generic (Alvogen) I've received the past few times for the IR version has felt much stronger and has ultimately led to me adjusting to about half my prescribed dose. I've taken the same dose produced by many different manufacturers for ~10 years and this is the first time I have noticed such a big difference. So far I haven't been able to find any other confounding factor that would account for the change in effect.

Eduard 4y ago
Maybe your batch got all the killer, the others filler.

gtop3 4y ago

Are there any concerns that the reduction in prescription stimulant supply/quality will cause some individuals to substitute their prescription medication for illicit methamphetamine or cocaine?

LoveMortuus 4y ago
I would say yes. Legal status of stuff doesn't really affect the demand, it just affects the regulation or should I say, if it's illegal it's not regulated. If someone wants weed or mushrooms they'll find a way to get them regardless of their legal status. Although it's been many years, I do speak from experience.
PragmaticPulp 4y ago
Recreational stimulants medications don't substitute for ADHD medications. You can always find anecdotes from people who think they're going to use some street drug as a substitute for ADHD medication, but it always ends poorly. Proper ADHD treatment requires stable dosing. It's impossible to dose street drugs accurately due to the varying quality and different "cuts". Even with precise measuring, a person could end up dosing twice as much from one batch to the next. I browse recreational drug forums occasionally to see what people are doing these days. Even the recreational drug users on Reddit will readily admit that trying to use research chemicals or street drugs for therapeutic purposes is a dead end. It just results in abuse-style patterns as people chase the high and subsequently crash. If people are really struggling, the real solution is to try methylphenidate or the various non-stimulant ADHD options. The non-stimulant options aren't as "fun" and can take a few weeks to kick in, but they beat the stimulants for a lot of people who have the foresight to try them and stick with it. They also seem to be much less prone to tolerance over time.
pcthrowaway 4y ago
I'm literally trying to figure out how to do this safely right now. I have a person I can get it from, it's decriminalized where I live, and there are abundant facilities for detailed testing so I can get a sense of what the purity is. Just wondering about dose and how this could work. I'm ADHD and it's been impacting me a lot recently

Reptur 4y ago

This is 100% happening, we need these pills tested in a lab. My bet is they are likely thinning it because the demand is too high. The DEA will not approve the new limits because of "The War on Drugs" is being revived. I was switched to Teva at same dose this past month because of the shortage and it does not work at all. Its very frustrating, like getting your wheel chair and realizing it doesn't have wheels.

Shank 4y ago
The Teva generic or the Teva brand name? They make both a generic and a brand-name. Everyone I've heard swears by the Teva non-generic as "the best" for just adderall.
- Reptur 4y ago
  generic adderall

DontchaKnowit 4y ago

Havent seen any mention of this yet but the reason for this is well known in the recreational drug community : amphetamine is a chiral molecule. The D isomer is more psychologically active. The L isomer creates more physical side effects. There is no regulation for the % of each isomer in the product. This means that one brand may be 70% L, 30% D, and a different brand could be the opposite. I take this drug daily. The current supply crunch has meant I've had to take inferior versions of the product for nearly a year now. It fucking sucks. I need it to work but the side effects often mean little sleep, strange repetitive behaviour, absurd hypersexuality, etc. Its a travesty, not in the best interest of the consumer. If you are on this medication you are treated like dog shit from the doctor to the insurance company to the pharmacy to the pill itself. All in the name of either preventi g addicts from getting it (who cares?) Or making more money for some massive company.

robotastronaut 4y ago
Man, this helps me understand so much of what I’m experiencing. I had to switch to cheap stuff about two months ago and I’ve been all over the place. Absolutely terrible sleep, too.
refurb 4y ago
There is no regulation for the % of each isomer in the product. Do you have a source? The FDA label says it's 50% d,l-amphetamine (50/50) plus 50% d-amphetmaine, so you end up with a 3:1 ratio of dextroamphetamine to levoamphetamine. Why would a manufacturer do more work to change the 50/50 mix? And why would it vary from batch to batch? The FDA has requirements on manufacturing that each lot is made to the same specifications. The more reasonable explanation is that the binding agents changed, which may change the rate at which the drug dissolves and is absorbed. This actually happened a while back with generic bupropion. Generic manufacturers made a 300 mg version, which had 300 mg of drug in it. However, the medicine was absorbed much more quickly leading to a rash of side effect complaints from patients. The FDA eventually recalled the drug. If you want to read how generics are tested and approved, Derek Lowe did a nice blog post on it: https://www.science.org/content/blog-post/generic-wellbutrin-problem-whose-fault-it https://www.science.org/content/blog-post/generic-wellbutrin... "In that study, the results of which became available in August 2012, Budeprion XL 300 mg failed to demonstrate bioequivalence to Wellbutrin XL 300 mg."

LoganDark 4y ago

Some of these "differences" can be life-threatening. I'm on 30mg of generic dextroamphetamine sulfate XR per day. It evaporates my ADHD entirely, makes me feel much more comfortable and relaxed, and makes it easier to regulate emotions and stress. As a bonus it also helps me feel my emotions more readily, which I consider amazing. But last time, the brand of generic that my pharmacy gave me was Actavis (owned by, guess who, Teva) instead of the Mallinckrodt that I got the first time. When it first kicked in, I was in the middle of relaxing in bed and my heart just suddenly went completely insane out of nowhere. My heart rate was around 130bpm and I could not sleep at all anymore, even with generous amounts of melatonin 4+ hours before bed. My blood pressure was 180 over 130 for two days straight. I eventually realized what the problem was and switched back to Mallinckrodt. My heart rate was soon okay and I could relax and sleep again, but it took around 4–5 days for my blood pressure to return to safe levels, probably because of all the bodily load that those Actavis capsules caused. At my doctor's appointment yesterday, I had my doctor explicitly forbid Actavis and then put "brand medically necessary" on my latest prescription three times, once in handwriting, requiring Mallinckrodt specifically. Hopefully I will not get the wrong meds again. AFAICT, the main reason it was so dangerous is probably because I am taking 30mg daily. But either my ADHD is really that bad or I started off with a very high tolerance, because my tolerance was discovered from having to take 20mg of adderall IR for it to do anything at all. And that just so happened to be terrible badness, so I switched to pure dextroamphetamine which seems to work wonderfully. But only this very specific capsule from this very specific brand. The others might literally cause me a heart attack.

TechBro8615 4y ago
I am on a similar script, and I think the half life on these pills is way longer than commonly advertised. The primary effects last 4-6 hours, sure, but the actual half life is more like 12 hours. I will absolutely not be sleeping within 4 hours of taking 15mg of dexamphetamine. Wikipedia also seems to confirm this (duration of effect vs. elimination half-life) [0]. The implication of that is that if you take the same amount every day you can build up a wall of toxicity. I recommend skipping your dose on the weekend, or cutting it significantly and only taking it in the morning. I find this helps me keep the effects feeling more even over time. Also, maybe I should start drinking a glass of orange juice a few hours before bed to try to accelerate the excretion. [0] https://en.wikipedia.org/wiki/Dextroamphetamine https://en.wikipedia.org/wiki/Dextroamphetamine

henearkr 4y ago

Or, maybe an increasing number of people have suffered from brain fog caused by long covid, and that would make them feel like their Adderall is not working?

DontchaKnowit 4y ago
Nope. Line up 4 different brands of amphetamine salts and try them on different days. You will find that some make you feel geeked and strung out. Some make you feel calm and focused.
- henearkr 4y ago
  Good point.

bosch_mind 4y ago

Is it still the case that many folks can’t pick up their script at all independent of the manufacturer? Curious how long the wait is

frogger8 4y ago

Noticed this as well. Now I can’t find that generic in stock either. As an alternative, I would like to know what THC / medical Marijuna product is the best alternative to out of stock Adderall. I will take my answer off air. Click

trashface 4y ago

The near future: you pay full price for a drug, your insurance pays full price, and you get a watered down or fake med.

lazystar 4y ago

I'm considering going back to smokeless tobacco because of this sitution. For 400 years, the majority of the population used tobacco/nicotine for increased concentration. Over the last 30 years, that rate has declined, while at the same time, ADHD diagnoses have increased. Studies have shown nicotine is effective in reducing ADHD symptoms, so it seems that society's elimination of nicotine has revealed that it was covering up ADHD for all those years.

ofchnofc 4y ago

This thread is FASCINATING to read -- My brand of Adderall changed recently. I even more recently decided to try going off of it. I miss it. Somewhere here wrote that it helped them be in touch with their emotions. I can give up the focus, I can give up the productivity, I can give up the impulse control. But losing the fast instinct to stick up for myself, ask for what I want, express my needs before they overwhelm me... ... it's a bummer to think that Adderall really was helping me and that it wasn't simply a matter of fixing my depression/perspective.

rastamutta 4y ago

[flagged]

pmoriarty 4y ago

Do these amphetamines make people more talkative? I recently met someone who says they take Vyvanse for ADHD and they just can not shut up, and constantly butt in on conversations to tell everyone about themselves. I didn't know this person before they started taking these meds, but I suspect these meds might be a contributing factor to that behavior. Could that be so?

dasv 4y ago
That is the ADHD. Constantly changing the topic to talk about something that happened to you once which you were just reminded of because of a detail in the conversation. Too much sharing of personal details with people I maybe just met. Telling too much to someone in spite of knowing that I should have shut up. It has taken me ages to be fully aware that I do it, and when I notice I try to stop myself from derailing the topic being discussed. If I feel that it is truly relevant I cross my fingers or something like that to add it at the end of the conversation, but usually after a few seconds it loses the urgency and I feel I can drop it, or even forgetting what I wanted to add at that point. It is absolutely a social problem and I know people see it as a flaw of character, but it is slowly getting better. Being gently reminded that I am doing it helps because sometimes you just don't notice. Of course if your acquaintance is on a too high dose of Vyvanse or has been wrongly diagnosed it can cause a bad case of motormouth, as all stimulants do...

t0bia_s 4y ago

I wonder why we in modern west medicine focus so much to extinguish the consequences but ignore causes of illness. Would it ruin business for pharma companies?

samtho 4y ago
This is an unhelpful and incorrect sentiment in the context of ADHD medication. The cause has been linked primarily to genetics as ADHD in particular is caused by the brain not producing enough dopamine (or cleaning it up too quickly) to function well in our society. It is also not endemic of modern times as there is evidence that ADHD has been with the human race since it existed. Stimulant type drugs are some of the most effective drugs we have to treat the conditions they target, because it counteracts precisely the mechanism (dopamine production/retention) that is deficient in ADHD brains.
- t0bia_s 4y ago
  Ah... Genetics. Sure. What about level of sugar that we consume almost in everything? Are there ADHD diagnosis in... Africa?
  - samtho 4y ago
    Diet has been strongly linked to mood, focus, and sleep. Consequently, the hormones Dopamine, Serotonin, Epinephrine, and Norepinephrine all have receptors in the brain as well as the gut and this should not be too surprising because consuming calories, vitamins, and water is fundamental to survival. In fact your gut has 100 million neurons in it, more than a dogs brain. While it’s not “thinking” in the way we know as consciousness, it does make decisions and pull levers to motivate you to do stuff. It should come as no surprise that dumping refined sugar into this system, something we did not evolve to process in its current form, will cause issues. ADHD is a sort of misnomer, it doesn’t describe a deficit of attention but rather intention. It messes with the wiring of your prefrontal cortex to limit the effectiveness of executive functioning which handicaps your ability to make decisions based on importance (because everything seems just as important) and the brain makes it very unpleasant to start tasks that non stimulating (to the point of withholding dopamine and dumping cortisol into the bloodstream). There is plenty of ADHD in Africa but you need to find it in the places where non-ADHD brains are rewarded. I suspect that as African nations become more metropolitan and the workforce demands shift to meeting the needs of a city, we will see even more ADHD diagnosis in this part of the world.

jshaqaw 4y ago

What alternative medications are people finding effective and smooth transitions for real ADHD users who can’t deal with this instability anymore?