4 ms·

Amphetamines are beneficial drugs for many people, and the status quo is that anyone can get a legitimate prescription for them by doing little more than asking

Amphetamines are beneficial drugs for many people, and the status quo is that anyone can get a legitimate prescription for them by doing little more than asking. It's just a matter of finding a psychiatrist and explaining you have symptoms of ADHD. There are no physical symptoms, so it's impossible to verify one way or the other. Some might say that means that a drug seeking patient can "trick" their prescriber. But I'd argue the entire field of psychiatry is a "trick," and that effectively, if you think you have symptoms of ADHD, then you may as well have it. If you want to try treatment (amphetamines), then you should have a right to do that. As it stands, you already de facto have this right. But you need to do this whole song and dance with finding a doctor, paying the fees, and getting the pills. Yes, online telemedicine has made this easier to "abuse" (see above: it's not possible to abuse a diagnosis that is fundamentally based on perception of deviance from the mean). But even prior to online psychiatry, it was easy to legally procure such medication with a little extra effort. We should dispense with this charade and focus on safe and effective treatment of symptoms for those who want to try it. The goal of a prescriber should therefore not be to gatekeep access to the medication, but to manage its dosage and monitor patients for positive outcomes from healthy usage of the medication.

api 3y ago
We should have easy to obtain or even OTC Vyvanse or some similar stimulant that is abuse resistant. (Vyvanse is turned into amphetamine in the liver, rate limiting absorption.) It would probably help a lot of people and at the same time reduce the number who get into dangerous street stims like meth. Low dose time release Vyvanse would probably be no worse than a lot of caffeine or these energy drinks full of megadoses of taurine and stuff. Amphetamine is actually not that dangerous if taken at reasonable doses and not abused. Street meth is impure, uncontrolled in dose, and delivered without proper packaging.
- aidenn0 3y ago
  I'm ADHD and I respond terribly to amphetamine (or Vyvanse). On low doses I become more irritable (or in my wife's words "an asshole"), and the one time I took a higher dose (at the instruction of my psychiatrist because I wasn't getting a therapeutic effect at the lower dose), I had a manic episode and was awake for 36 hours straight. Finally settled on Focalin as working for me, but every time we changed insurance companies I had to spend a few hours on the phone proving to them that amphetamine doesn't work, while paying out-of-pocket until they are convinced.
- ipnon 3y ago
  If you’re interested in Vyvanse then check out this interview of its creator Dr. Robert Oberlander: https://youtu.be/x9WmEVRxebE https://youtu.be/x9WmEVRxebE
- waswaswas 3y ago
  I'm way too ADHD to hold an engineering job without medication. I'm also quite sensitive to amphetamines. Vyvanse gave me terrible insomnia, and the extended time release worsened the psychiatric side effects (depression, social anxiety, paranoia) when taken in large enough doses to aid focus (which were always pretty low in absolute terms). Vyvanse basically ruined my life in high school in part because my psychiatrist was afraid to prescribe those pesky abuse-prone IR amphetamines, but I felt I had to keep taking them because it was my only way to succeed academically. Having also been a heavy caffeine user over the years, I think Vyvanse is in an entirely different ballpark. I'm now managing my ADHD effectively by taking low doses of Adderall on an as-needed basis (average of probably 90 days per year, <10mg per day). Minimal insomnia, minimal depression, no paranoia. SSC's article is the best concise discussion of ADHD and medication I've ever come across: https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
  - opportune 3y ago
    Anecdotally I have the same problem - I was really well managed with adderall IR but now I’m on vyvanse because of the shortage. I think the problem is it never fucking wears off - sounds good on paper but the cumulative effects of dehydration, not eating as well, and not sleeping as much really take a toll on you. Plus while it technically lasts longer, for a lot of that tail end it’s barely effective at managing ADHD (acute tolerance, depletion and tiredness) while still messing with sleeping/eating/hydrating. I honestly think adderall IR should be legalized too if we’re going to legalize vyvanse - just put it behind the counter like Sudafed. This stuff was legal, widely used, and widely available in many countries (Germany, the US) for multiple decades and it didn’t collapse their societies. If you read about it, generally the only times it caused problems was armies and such ran out - what people experience right now with all the shortages that wouldn’t exist if it were treated like Sudafed. Sounds like it’s scarily addictive given that, until you realize we’d also have a lot of problems if we ran out of coffee or caffeine.
    - TechBro8615 3y ago
      I prefer IR (raw dexamphetamine) because its predictability makes me feel more in control of its effects, even if they are more volatile, with the temporary "high" for the first hour followed by a gradual dulling over the next few hours. But at least I can be relatively certain of when it will end. Whereas XR might be more consistent throughout the day, but the total duration is variable and depends on factors like how much food I ate or how much acidity was in my drink. I only tried XR for a few weeks during my initial titration period years ago, but that's how I remember it. I've been on IR dexamphetamine for ~10 years now at varying levels of dosages depending on current life goals. Overall it's been worth it, but there are tradeoffs with dulling of personality and risk of misdirected focus (see my comment history). It's not conducive to long term relationships, and once I "settle down" I might reevaluate my usage of it, but for now it's the obviously right choice. I'm not 100% productive every day, but I'm significantly more consistent than I was without it.

api 3y ago

We should have easy to obtain or even OTC Vyvanse or some similar stimulant that is abuse resistant. (Vyvanse is turned into amphetamine in the liver, rate limiting absorption.) It would probably help a lot of people and at the same time reduce the number who get into dangerous street stims like meth. Low dose time release Vyvanse would probably be no worse than a lot of caffeine or these energy drinks full of megadoses of taurine and stuff. Amphetamine is actually not that dangerous if taken at reasonable doses and not abused. Street meth is impure, uncontrolled in dose, and delivered without proper packaging.

aidenn0 3y ago
I'm ADHD and I respond terribly to amphetamine (or Vyvanse). On low doses I become more irritable (or in my wife's words "an asshole"), and the one time I took a higher dose (at the instruction of my psychiatrist because I wasn't getting a therapeutic effect at the lower dose), I had a manic episode and was awake for 36 hours straight. Finally settled on Focalin as working for me, but every time we changed insurance companies I had to spend a few hours on the phone proving to them that amphetamine doesn't work, while paying out-of-pocket until they are convinced.
ipnon 3y ago
If you’re interested in Vyvanse then check out this interview of its creator Dr. Robert Oberlander: https://youtu.be/x9WmEVRxebE https://youtu.be/x9WmEVRxebE
waswaswas 3y ago
I'm way too ADHD to hold an engineering job without medication. I'm also quite sensitive to amphetamines. Vyvanse gave me terrible insomnia, and the extended time release worsened the psychiatric side effects (depression, social anxiety, paranoia) when taken in large enough doses to aid focus (which were always pretty low in absolute terms). Vyvanse basically ruined my life in high school in part because my psychiatrist was afraid to prescribe those pesky abuse-prone IR amphetamines, but I felt I had to keep taking them because it was my only way to succeed academically. Having also been a heavy caffeine user over the years, I think Vyvanse is in an entirely different ballpark. I'm now managing my ADHD effectively by taking low doses of Adderall on an as-needed basis (average of probably 90 days per year, <10mg per day). Minimal insomnia, minimal depression, no paranoia. SSC's article is the best concise discussion of ADHD and medication I've ever come across: https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
- opportune 3y ago
  Anecdotally I have the same problem - I was really well managed with adderall IR but now I’m on vyvanse because of the shortage. I think the problem is it never fucking wears off - sounds good on paper but the cumulative effects of dehydration, not eating as well, and not sleeping as much really take a toll on you. Plus while it technically lasts longer, for a lot of that tail end it’s barely effective at managing ADHD (acute tolerance, depletion and tiredness) while still messing with sleeping/eating/hydrating. I honestly think adderall IR should be legalized too if we’re going to legalize vyvanse - just put it behind the counter like Sudafed. This stuff was legal, widely used, and widely available in many countries (Germany, the US) for multiple decades and it didn’t collapse their societies. If you read about it, generally the only times it caused problems was armies and such ran out - what people experience right now with all the shortages that wouldn’t exist if it were treated like Sudafed. Sounds like it’s scarily addictive given that, until you realize we’d also have a lot of problems if we ran out of coffee or caffeine.
  - TechBro8615 3y ago
    I prefer IR (raw dexamphetamine) because its predictability makes me feel more in control of its effects, even if they are more volatile, with the temporary "high" for the first hour followed by a gradual dulling over the next few hours. But at least I can be relatively certain of when it will end. Whereas XR might be more consistent throughout the day, but the total duration is variable and depends on factors like how much food I ate or how much acidity was in my drink. I only tried XR for a few weeks during my initial titration period years ago, but that's how I remember it. I've been on IR dexamphetamine for ~10 years now at varying levels of dosages depending on current life goals. Overall it's been worth it, but there are tradeoffs with dulling of personality and risk of misdirected focus (see my comment history). It's not conducive to long term relationships, and once I "settle down" I might reevaluate my usage of it, but for now it's the obviously right choice. I'm not 100% productive every day, but I'm significantly more consistent than I was without it.