The adderall shortage is because the DEA sets quotas on how much can be made per year. Despite increased prescriptions, the amounts produced have remained the same.[1][2]
The Wegovy shortage is because it was recently approved to treat obesity. The number of new prescriptions was larger than Novo Nordisk predicted, so they're still ramping up production.
> According to DEA's data, manufacturers have not fully utilized the APQ for amphetamine in support of domestic manufacturing, reserve stocks, and export requirements for the past three calendar years 2020, 2021 and 2022.
> Based on this trend, DEA has not implemented an increase to the APQ for amphetamine at this time.
Which suggests that the DEA's quota for adderall is not (yet) to blame.
> The majority of the manufacturers contacted by DEA and/or FDA have responded that they currently have sufficient quota to meet their contracted production quantities for legitimate patient medical needs.
“The majority” “legitimate patient medical needs” sounds like a bunch of trippy legalese. If it’s the majority of the manufacturers they contacted, doesn’t that mean that there’s at least one that has exhausted their production? Could that one perhaps be the largest one, like Teva?
If that’s the case, then yes, there could be a shortage. And they’re not increasing it because there’s been a surge of “illegitimate” shops that have popped up and prescribed remotely since Covid that the DEA is investigating and/or shutting down.
And that may not even be the real reason. Could be the understaffing issues quoted in august. Either way, that answer from the register is a non-answer.
> If it’s the majority of the manufacturers they contacted, doesn’t that mean that there’s at least one that has exhausted their production? Could that one perhaps be the largest one, like Teva?
Also, if any one doesn’t have enough, that increases the amount needed for legitimate patient needs for all the others: either (1) they all have enough for legitimate patient needs, or (2) none of them do.
And, here’s the thing, if there are patients with prescriptions who aren’t able to get them, or are having to scramble to call around to different pharmacy chains with different contracted suppliers to find one that isn’t out and unable to restock the particular dosage capsule (because they aren’t fungible) of the particular drug they are prescribed, then, no, there aren’t enough for legitimate patient needs.
“But some prescriptions are illegitimate” – maybe, but supply constraints don’t fix that or target illegitimate prescriptions, they just make it (well, until all supply is exhausted, then everyone is SOL) a lottery for every patient, regardless of legitimacy of their prescription. It adds a whole new problem, rather than solving the notionally motivating problem, and it is so obvious that this is the case that either the people adopting the policy are the biggest fucking idiots in the world, or the policy is outright malicious and not directed at the problem that supposedly justifies it. (Since its part of the War on Drugs, the second option is guaranteed to be part of it.)
>Could that one perhaps be the largest one, like Teva?
maybe, but from my experience with governmental writing it probably means that there are a bunch of companies and some smaller companies they don't want to point out for some reason have exhausted production. If it was the largest company exhausted I would expect it to say something like
"although the majority of smaller companies still have not exhausted their productive capabilities, the larger suppliers report that they cannot produce more at this time"
Also - I would generally expect that largest suppliers exhaust their capabilities after the smaller suppliers exhaust theirs - although I guess some supply chain studies probably exist that would say if my expectation is off.
The DEA is not supposed to be restricting prescriptions, it is supposed to be restricting production to what is necessary for prescriptions so there isn't a bunch of controlled substances being sold without prescriptions. If there is a mismatch, it is always a failure on the DEA's part to keep up.
The DEA isn't restricting prescriptions though, they're restricting production capacity.
Even without all the usual overhead of government bureaucracy its not reasonable to assume a central authority could accurately predict supply needs for legitimate prescriptions, let alone keep that number up to date over time.
They're always going to be wrong with their estimates. Unless there's proveable intent behind them underestimsting, what's the problem?
My reply focused on the implication only intent mattered. I mostly ignored the assertion it would be impossible to revise quotas promptly seemed secondary and was unsupported.
It leads you to an argument for less regulation and smaller federal government because you need no leading. People who prefer more nuance may not follow.
Is intent all that matters? If a person admits to having committed a crime should they be let go depending on their intent? And how do we prove intent, short of verifiable documents with a person stating their motives prior to actually doing it?
I.e. do we have evidence the DEA purposely underestimated, and that they did it to harm individuals by making it harder to fill legal prescriptioms?
> I mostly ignored the assertion it would be impossible to revise quotas promptly seemed secondary and was unsupported.
I honestly just didn't think support was needed with regards to the slow, inefficient process of our federal government. We only attempt to run the national census once every 10 years and do a piss poor job at it. The IRS, which is literally responsible for a enforcing a primary revenue driver for the government, can't manage to catch blatant (rhoguh elaborate) tax evasion by corporations and the rich. The FAA asked Boeing how safe their new plane was and was months late grounding the Max after an obvious issue.
The list can go on, but suffice it to say there are plenty of examples where entities in our federal government completely failed to regulate the very industries they were responsible for and seemed to be the last to know when things weren't working.
I'm not wvwn trying to defend the DEA here. I simply don't get what we could expect them to do if thwybare tasked with keeping supply inoine with demand without underestimating at all. That's an impossible needle to thread and seems to shows that granting that power to them is only a losing scenario.
Error is unavoidable, the problem is that they are erring on the wrong side and not fixing their mistake in a timely manner.
Estimates should include some factor of safety so they are still adequate even with the error, and they should be regularly reevaluated so that discrepancies do not persist long enough to result in production shortages. As previously noted, the DEA's restrictions have been significantly too low for years.
I'll throw this on my "smaller government" pile :)
If error is unavoidable and any underestimate is untenable, the regulation isn't feasible and the DEA (and the federal government in general) simply shouldn't have this power.
Isn't that a federal government problem in general though? When was the last time they actually responded quickly to something without drastically over or underestimating the response needed?
It took me 6 months to get back to a decent baseline after quitting Adderall cold turkey but I am really glad I did. I hate being dependent on a drug with limited access for survival. In all honesty it is truly no different than being an alcoholic or a crack addict. Virtually every interaction you ever have with a psychiatrist or pharmacist surrounding these meds is fraught with bullshit. It is easier, less stressful and arguably more dignified buy illegal drugs on the black market.
Covid was a sobering event for me and it made me realize just how fragile our global economy / supply chain are. I want to be able to exist and survive even in a total collapse (which, tinfoil hat be damned is becoming a more and more realistic possibility). Step 1 was giving up the amphetamine salts.
Your dependency isn’t the problem if you have ADHD and the medication helps you. The actual problem is all the bullshit around getting the drug and the bullshit stigma around it.
The fact the system treats you like a ‘crack addict’ is the problem. Could you imagine how absurd it would be if say, type 1 diabetics got treated like addicts because they depended on insulin?
The system around ADHD drugs is just fucked and needs to change.
The problem is that ADHD medications actually work. They work so well that they are abused by people who don't actually have ADHD. Resulting in more restrictions, even for people who do have ADHD and actually need the drug.
Insulin can't be abused in this way, which probably explains why you can just go and buy it at walmart.
> What would be the worst thing that happened to society if we just manufactured adderall and sold it OTC?
Honestly I agree with you. I think drugs like this should be sold OTC because it's basically just like food. It is a substance you put into your body. Just like psychedelics.
And imagine the lives that would be saved if the drug propaganda did not desensitize everyone to actual help. This is the whole reason "harm reduction" forums exist.
But, you know how it is, where the government doesn't trust anyone to use substances responsibly.
Man, what I would give for a "responsible enough to buy drugs OTC" license or whatever. I get dextroamphetamine on prescription, but I also really like LSD and would love to be able to buy that OTC, legally, so I'd know the supply is safe and I'm not going to jail.
Although, I'm pretty sure certain drugs like heroin compromise judgement to a great degree, which makes it very difficult to use responsibly, but honestly there are more creative ways to deal with this that society just hasn't explored because of the whole "war on drugs" ridiculousness.
The war on drugs has substantially ruined entire generations by convincing people drug abuse can be solved purely by throwing people in jail and through shame.
To think it's taken until ~2021-2022 for a federal administration in the US to finally admit there needs to be better solutions in place, it's absurd! All those deaths could have been prevented.
Yep... drugs are powerful substances that deserve to be treated with respect, but past that, it's possible to use them responsibly. The fact that some substances are just indiscriminately illegal is just... upsetting. Especially since even things like LSD are lumped into that "Schedule I" despite being... extremely safe? Given you're properly informed and prepared for the experience, of course. Only an example, but it's a particularly personal example.
I just think it's a bit sad how "don't talk to me before my morning coffee" and etc. is normalized just because so many people have that problem.
Some people legitimately need the caffeine just like some people legitimately need ADHD medication, but some people became dependent on caffeine when they didn't necessarily have to be.
> Sure. But shouldn't it be left to the individual?
Honestly, if someone chooses to be dependent on caffeine because they know and consent to it, that's fine I guess, though unfortunate. The problem is that caffeine use is so normalized that people seem to have forgotten that one even can become addicted or dependent on it—I would say "glorified" but that's a bit far.
FWIW, I have some friends who are trying to quit caffeine. Not because I told them it was an issue, but because they independently decided that. I am somewhat biased by seeing cases of actual caffeine addiction and dependence, whereas most people only see the benefits of taking it. This is probably how the normalization happens, some people just don't know any better.
>The problem is that caffeine use is so normalized that people seem to have forgotten that one even can become addicted or dependent on it—I would say "glorified" but that's a bit far.
Seems like the solution is better education on the effects of caffeine and not putting it into the same category as drugs and alcohol. So far I'm yet to hear of people who's lives were ruined by coffee addiction.
The fact that it makes you uncomfortable that people are dependent on coffee is kind of irelevant IMHO. We live in a free society. Let people have their coffee if they want it.
Once you get harassed or mugged by someone on coffee withdrawal who needed a fix, then we can talk about regulating it.
> Seems like the solution is better education on the effects of caffeine and not putting it into the same category as drugs and alcohol.
I... regret to inform you that caffeine is literally a drug, stimulant class.
> So far I'm yet to hear of people who's lives were ruined by coffee addiction.
I'm not really sure what your point is here, as I'm not saying caffeine addiction ruins lives, just that it's a thing that could be avoided more than it is now.
> The fact that it makes you uncomfortable that people are dependent on coffee is kind of irelevant IMHO.
>I... regret to inform you that caffeine is literally a drug, stimulant class.
I regret to inform you that not everything classified as a drug is equally bad as all the other drugs, in fact many drugs are useful in certain situations.
It's not black and white, "drugs are bad m-kay", as you want it to be. Which is why coffee is tolerated.
So I don't get your hissy fit on people consuming this particular drug. If you don't want it, then don't drink it, just let others enjoy it, since it has no negative effect on you.
Yup. Adderall is probably better for you than coffee. Especially if you are drinking copious amounts of coffee because you have undiagnosed ADHD and are self-medicating with caffeine (which, again, properly belongs to the category of stimulant medication) without even realizing it.
Regularly consuming large amounts of caffeine while barely feeling any effect (beyond getting jitters / bowel issues) or feeling calmed by it, is actually indicative of ADHD.
So I'm almost 40 now, was prescribed to ADHD meds from around ages 10-28, mainly Adderall as that just worked best.
At 28 I stopped Adderall because I honestly don't care for the side effects, and felt like I had good enough habits to do without it.
That worked for a while, but I was at a job that wasn't too challenging for 6 years (and very underpaid as a result of not being more ambitious/focused)
Switched to another job, ended up getting promoted to lead, then everything came crashing down. Couldn't focus, and as I fell further behind I'd feel more stressed and overwhelmed constantly.
I had been drinking coffee the whole time, but it wasn't helping that much. Irritated my bowels pretty badly though (I ended up needing surgery for a complication of what turned out to be Crohns, though my symptoms are incredibly mild when I'm not drinking over 4 cups of coffee per day).
Finally got back on Adderall after ~10 years unmedicated and was able to just stop coffee. My entire life has improved. I can focus during work hours and even have some free time during the day, since I'm not spending the entire day struggling to get work done.
I can honestly say that Adderall is much more helpful for me, and has minimal physical side effects compared to copious coffee (though I do have mental/emotional side effects, which are honestly less negative than the stress that accompanied being constantly overwhelmed, exhausted, and sleep-deprived)
The process to get my prescription in Canada took almost 2 years (in part because of my poor ability to navigate the labyrinthine health care system due to said ADHD)
But wow, has it already improved my quality of life significantly in the ~1 month I've been back on it. I agree with other posters here that we should just let people get it OTC or allow diagnosed individuals to just get a lifetime prescription
> It's not black and white, "drugs are bad m-kay", as you want it to be. Which is why coffee is tolerated.
You clearly haven't been paying attention to my comments if you think I'm saying anything like "drugs are bad".
I'm saying undue dependence on something that you didn't need to be dependent on, is unfortunate. As in, it's unfortunate how people can accidentally fall into caffeine dependence without knowing what they are getting into, because it's not that people don't think caffeine is evil, it's that people think caffeine is completely harmless.
Of course they're not exactly like food. They are powerful substances that deserve respect and you can't just "eat" them when you are "hungry" like you can with normal food. But I believe they're like food in the way that you deserve bodily autonomy wrt taking them.
Fun fact: Did you know hunger is basically just carbohydrate withdrawal? If you stop eating carbs for around 1-2 days, your hunger will go away. Obviously, if you want to stay that way, you will have to find some way to sustain yourself without carbs, but it's a relatively safe experiment to fast for a few days and see what happens.
It's fun to think of food in that way because actually... food is just a pile of substances! Carbs, fats and proteins.
It's just that food is generally safe to eat when you're hungry, but drugs are especially powerful substances that can be dangerous if misused. But still stuff that you can put into your body, through basically the exact same mechanisms as food.
I'm all for caution and research and responsibility and informed consent and all that—all good things. But I don't think drugs are inherently so much different than food that you don't deserve some level of autonomy with them.
In other words, I think the amphetamines and stuff should be OTC. Like... legalize them all, legalize everything. Not only would this make the supply safer for people who are already taking those substances, since they can be made by reputable, professional companies, but this would help get rid of the taboo around sharing safe dosage and supplement information, which would seriously help a lot of people (harm reduction!).
All the FUD around the war on drugs is just causing harm to the world. It's causing people to go to jail just from putting things into their own body, it's denying people access to safe medical information, it's barring medical professionals from helping people with substances that happen to be illegal, it's denying people a safe supply of their favorite drugs (which usually results in people going to shady sources, not abstaining completely), ... the list goes on.
Yeah, amphetamines aren't food, but it's nice to imagine a world where they're available freely and used responsibly. Unfortunately I'm not sure if that's a possible future.
Some people can use these things responsibly, but probably fewer than the number who think they can and many cannot at all. That's why doctors are there to help guide responsible use. I agree it isn't ideal for the subset of people who can use them well, but there are also further issues: your drug use doesn't just affect you but the culture around you. I think the analogy to food is pretty bad, since no one is born dependent on amphetamines and it is a manufactured product only invented recently (to be fair, too much of our food is also weird synthesised products which are not historically natural, but I dont think you have a strict natural right to frozen microwave dinners either). The analogy with food may work a little better with mushrooms, but also the effect of these is partially due to your body thinking it has been poisoned, so they arent really food either.
> If there is a referendum I am going to vote against this. Amphetamines are not like food, imo.
Would be nice if only people who are against drugs would pay some additional tax to sustain the whole prison-industrial-DEA-complex though. I don't do illegal drugs, but the fact that I'm forced to sponsor that due to other people's self-righteous puritanism is just stupid.
It would also be nice if the people who support softer drug laws paid a tax for all the resulting urban blight, health bills, property crime, violent crime, addiction, mental health issues, death etc. that results from drug use. The fact that I'm forced to live with all of that, often in danger, due to other people's selfish libertine delusions is unjust.
I think the real issue is that all it should take to get a prescription is a confirmation that you know the procedure for administering the proper dose and that you understand the expected efficacy and risks of doing so. It should be a process that could be completely handled by a kiosk. Maybe a drug won't help them, or even hurt them, but so long as they are informed they should have the right to make that decision for themselves. We let people buy peanut butter without demanding a note from a doctor saying they don't have a peanut allergy. Perhaps some things should have a traditional prescription but the burden on the government should be pretty high to prove that it's something so complicated or so dangerous that it would be catastrophic to permit direct sale to the public.
But boy does it come in handy for other things. It’s the best cold symptom medication there is. Need to drive late at night when you should be tired? Pop 5mg and you can actually drive safely for a few hours. It’s a shame we have it locked away.
That said, it’s dangerous to think other people would act like you. People would definitely abuse it (more than they already do). I come down on your idea like I do in most drug legalization questions. Conceptually I think we should be able to do whatever the hell we want to our bodies. Realistically I don’t know if that works for society.
Adderall is a mix of 3:1 dextroamphetamine to levoamphetamine. It is not "plain old amphetamine", also known as racemic or "free-base" amphetamine (equal mix of dextro- and levo-).
I can't take levoamphetamine, and need dextroamphetamine directly. Unsure if that was ever sold OTC on its own.
By plain old amphetamine I meant structurally, rather than a specific stereoisomer mix. Though I guess I had assumed it was 100% dextroamphetamine.
I think Dexedrine was sold OTC in the 50s and 60s, hard to be sure, sources I can find talk about it being popular for use by anyone and everyone, from dieting housewives to truck drivers and athletes, but don't specifically mention it being OTC or prescription.
Charles Whitman was dependent on Dexedrine, and he packed a good supply of it on that last day of his life. Dexedrine and other psychotropic pharmaceuticals have figured prominently in most mass shootings since that time.
Assuming this was true, did most shootings also involve cigarettes? A lot of people smoked at that time, so I would presume there were a lot of smokers doing shootings.
Sounds more like correlation to me than causation.
Yes; just check the label of SSRIs and other drugs when they first came out. Many carried an FDA-mandated, black-box warning of increased incidences of homicidal ideations. Not merely suicidal ideations, homicidal ones. This was largely regarded as a bad idea and detrimental to sales, so it was walked back.
That's tangential at best and I'm not sure it supports the strong claim - "Dexedrine and other psychotropic pharmaceuticals have figured prominently in most mass shootings since that time"
I'm not saying I don't find it plausible, but a warning message on the box isn't exactly the confirmation I was looking for.
You know that feeling that most impressive leaps in engineering and technology in general all happened in the 20th century, especially between 1950s and 1980s, and that we've somehow lost the ability to do big things?
> JFK was regularly using meth. It created a lot of problems.
Problems caused by drug abuse != problems caused by drug availability.
Meth is neurotoxic, we know this now. So are all stimulants, to a degree. I take magnesium supplements with my ADHD meds because it depletes my brain of natural magnesium—I have had blood tests confirm this. But meth can be particularly dangerous, especially due to how addictive it is and how neurotoxic it gets when abused, compared to even the other amphetamines like dextroamphetamine.
All this is not to say that it shouldn't be widely available. Just that proper, responsible usage information should also be widely available. Which it is not.
If people knew how to take meth properly and responsibly, maybe there would be less cases of it getting out of control.
Too bad all people have to go off of is anti-drug propaganda that says all drugs are bad. Leads to them ignoring all advice altogether, even if it could've otherwise helped them.
You’re going to have a curve of abuse. Availability will affect that curve.
Drugs like opioids and stimulants are great in that they work well at masking lots of symptoms, but our bodies adapt to them and the need for them feeds the physical dependence.
The mental abuse factors amplify as well availability. Bookies and sports betting isn’t novel. Legalized betting on smartphones is; so now billions are spent on marketing to vacuum up many billions of dollars of bets.
Humans are wired the way they are wired. Education about risk only benefits people capable of managing the risk - not the people likely to get addicted in the first place.
> Education about risk only benefits people capable of managing the risk - not the people likely to get addicted in the first place.
Sure, but people likely to get addicted are sometimes also in the presence of people who would benefit from a proper drug education in order to help protect the more vulnerable.
Am I saying people will stop using drugs if they stop being illegal? No way, the opposite actually. But if drug use wasn't considered indiscriminately bad, that wouldn't necessarily be a bad thing anyway.
As someone with ADHD that is absolutely correct. I could not properly pursue anything until I had basically decided that trying to find medication was my last resort before suicide.
Man, you know, I've been known to joke about how I have to take medication to remember to take my medication, but it sure as hell beats suicide. Glad you were able to push through and make it work.
> It might still be easier to get MAID (medically assisted suicide) here in Canada than Adderall. What a shitshow
Is there anything a random USAian could legally do to help your situation? I don't have a ton of financial resources, but if having someone in your corner helps, I might be able to do that for you.
I honestly have a pretty strong hunch that a high percentage of the people out there abusing the drug do have ADHD but are undiagnosed and self-medicating, technically needing it as much as anyone else. The difference is that not seeking treatment for things leads people down the road of substance abuse. I think that, more often than not, the situation tends to work out differently for people when approached from a clinical angle.
Oh, I've absolutely heard of people with undiagnosed ADHD who had to take meth or something because their doctor would not help them. It's just that without the help of a medical professional and prescription, it can pretty quickly spiral out of control based on the person's subjective judgement, which is notably impaired when euphoria-inducing drugs are involved (of which meth is a particularly notable example), and said spiralling becomes more dangerous when the drugs are easily neurotoxic (of which meth is also a particularly notable example).
Not to say responsible people don't exist, but rather that without a framework to support them, it's all their own personal responsibility. And there's also preliminary studies showing meth being somewhat neuroprotective at low doses, so if someone is using it purely for productivity, and taking the right supplements, it's possible that they could avoid damaging themselves too much.
But this is all theoretical and basically I don't fully believe in self-medicating for an ADHD case that you could be getting a real prescription for. I do believe in self-medicating using psychedelics and the like because there's no prescription treatment for that (yet), but as soon as you're allowed to ask a medical professional to help, I think you should.
FWIW even once psilocybin clinics become a thing, I'm still going to be taking LSD at home, because home has my toys and my friends, and clinics have neither. But if one day I can be prescribed LSD to take home and use on my own terms, I'd be glad to ask a professional for advice on it, and get a prescription. Just has to, you know, be legal first.
Insulin is abused by some bodybuilders as yet another gimmick in the quest for more size. There are likely other such niche uses/abuses, but that's one that came to mind.
So can gluten. I know (personally) at least one person where gluten acts as an opioid in their body. Don't remember the exact details but they get high from it and also get opioid withdrawals if they stop eating gluten.
Sounds like an incredibly miserable way to live, honestly.
I don't get high off gluten, but I do not tolerate it yet crave it, along with cheese, which contains casein that has the same opioid effect.
My favourite junk food, and one that puts me KO for 3 days is a double cheese pizza.
Makes me depressed and despondent, bloated and my ADHD meds stop being effective (but my usual dose is quite low on purpose). But that's because of my physiology, the opioid effect is in the strong craving, and how lovely the first bite is, and how I hate myself after the first bite, for having succumbed to its allure once again.
Gluten and casein are under-researched. The fact that there is a so called "gluten sensitivity" fad is not a shared hallucination, but some effect we haven't identified or understood yet.
That's interesting. If you were to make a protein shake with casein powder would that have a noticeable effect on you, or is it only when it is in cheese?
Dunno, never had a shake. I know milk has a slightly sedating effect, and I haven't been drinking it by choice most of my adult life. I can digest it pretty well I think.
Some people just hate that ADHD people have a better quality of life with stimulant meds, and want to believe they're just addicts.
There is no reasoning with that kind of people. I just hate they keep the stigma around ADHD and its very effective medication alive so we keep being branded as druggies.
Well, I am sort of a druggie, all things considered. Amphetamines were my gateway drug, they changed my entire perspective on drugs in general. But I think it's okay to be addicted. Just like I am addicted to eating food when I am hungry, or using a heavy weighted blanket when I sleep (~45lbs).
These are all things that I greatly enjoy and do whenever possible. And I think it's okay to enjoy things in life. I also think it's okay to enjoy drugs in life. Because while my meds finally let me relax and stop getting so painfully bored, they don't detract from my life, don't cause any adverse side effects (besides urinary retention, which is basically harmless), and don't even cause any adverse withdrawal symptoms.
I even take them around every 3 days now because sleeping for 15 hours in between feels nice. I don't have any obligations, so why take them every day if I can enjoy some really nice and comfy sleep in between? I don't get enough sleep on my meds anyway, 7 hours is the usual max I can get every night, so catching up is probably healthy too. Not to mention that my meds cause my preferences to flip a bit; I prefer entertainment while off meds, and productivity while on meds, and I want to keep both sides in my life.
I don't think anyone could make a convincing case that this is a bad thing. I am enjoying my life right now, and not harming myself or others, so~
I know addiction, I have been badly addicted to 4 distinct substances/things in my life, and by being respectful and cognisant of the risk of amphetamine abuse, after a year I can say it does not have much addiction potential at therapeutical dose.
Euphoria stops happening the second day you are on meds, and when they wear off there is no feeling whatsoever to redose. I honestly just feel I have done a lot and it's time to rest for the day. I am lucky it wears completely off by bed time, so sleep has been great.
In my experience, caffeine feels 10x as addictive than dexamfetamine.
> Euphoria stops happening the second day you are on meds
It didn't for me. It lasted something like two weeks. And after months it still sort of happens. The euphoria doesn't come directly from the drug, it comes from feeling free and relaxed and in control. From being able to lay in bed and do nothing and feel good about it. Without ever getting bored like what happens all the time without meds.
Boredom isn't supposed to be so painful all the time, but it normally is for me. Being free from that is euphoric regardless of the substance I'm taking, honestly.
I don't have any recent first hand experience with Adderall use, are we honestly at a point where those taking it are treated as crack addicts?
My understanding has always been that plenty of people use it, and if anything that is over prescribed. What exactly have you seen that's so bad it's being treated similar to a schedule 2 narcotic?
Well that I really should have fact checked first, could have sworn it was schedule 3! Societally aive never noticed adderall having the same stigma as crack, but I gotta say I'm pretty surprised it's schedule 2 (or 2N, I don't see any details on what the N distinction means).
Guess the question is whether a person really is at as high a risk for dependence when on Adderall vs. opiods and other schedule 2s.
It's a bit of a long read, but it's very good. The author is a psychiatrist who deals with this sort of thing frequently.
I can't really comment on the relative risk of dependence for Adderall vs opioids, except from my personal experience. A real addict probably wouldn't even (literally) get out of bed in order to take my daily dose of Adderall (25 mg XR).
I've been taking it for almost 10 years now, and in that time, I've had one dosage increase, from 20 to 25 mg. I've accidentally taken it twice in a day, and I can say with certainty that I do not enjoy the experience when that happens. I honestly can't fathom how anyone would want to take the kinds of doses that addicts take. It's not a fun drug at all, as far as I can tell. If I didn't have to take it to function somewhat normally, I wouldn't take it at all.
I know plenty of people buying and selling adderall on the streets, and it’s for recreational purposes. I don’t think insulin quite has that going against it.
Well, insulin doesn't have that going against it because you can just buy it from Walmart. It doesn't require any people on the street.
But the recreational use thing is huge indeed—the fact that adderall is so potent, desirable and dangerous is what earned it a spot on Schedule II. The reason why people are "treated like addicts" is because people think all addicts are the same.
There are different reasons to be addicted to a substance, and not all of them are bad. Say, if the substance legitimately helps you by making your brain function properly, as does ADHD treatment, it should be okay to be addicted. Who wouldn't be addicted to feeling like their brain is finally working properly?
But being addicted to a substance just because it feels good, with no regard for your personal safety or health (i.e. overdosing constantly) is reckless and dangerous, and this is what people think of when they think "addict". This is also, unfortunately, what comes to mind whenever one sees someone enjoying their ADHD medication.
They compare it to the enjoyment of someone who is well and truly fucking themselves with some neurotoxic substance like meth or cocaine—short-lived euphoria that goes away once the drug stops manufacturing good feelings for them, not true satisfaction with their self.
It's sad, really. Though I'm not surprised that people can't see the nuance.
I don't think type 1 diabetes meds are considered overprescribed _anywhere_. ADHD meds definitely are. Even reputable doctors say they are overprescribed.
How large % of the ADHD population could be fixed environmentally, e.g. by just going to the damn gym? How much can be attributed to our modern lifestyles?
ADHD exists, but to say that there's something wrong with "the system" just because 100% of people in society don't take it as a serious diagnosis is a big stretch.
Another big stretch is comparing ADHD with type 1 diabetes. Come on...
> How large % of the ADHD population could be fixed environmentally, e.g. by just going to the damn gym? How much can be attributed to our modern lifestyles?
It's complicated. I think a decent percentage could be helped by going to the gym, because I think the fact that SNRIs help so many people shows that norepinephrine can be the main issue in some cases, and exercise should help with that.
But then there are the cases that can only be helped by stimulants that are DRIs (like me, with dextroamphetamine), and most NRIs actually make things worse (e.g. my body can't handle the levoamphetamine in adderall).
I would love to know the distribution here, honestly.
As for the modern lifestyle, I think the modern tech world is trying to exploit ADHD-like behaviors in everyone. The whole thing about social media trying to maximize dopamine and instant gratification and endless scrolling and etc. is a real thing that happens to try to take advantage of even people who don't have ADHD... but it hits people with ADHD the hardest, because due to their disorder, deviously-crafted social media can actually overshadow the rest of their life.
I'm almost definitely addicted to chatting on Discord for example, ever since the platform first came out, but mainly because it facilitates chatting with my closest friends. I pick a DM and talk to people, and it's very direct, and I don't feel manipulated at all. But that's how it gets you; I know the majority of my time is spent chatting, and the majority of my time procrastinating is spent chatting. The only question is whether my decision is truly informed or not. I think it is.
> How large % of the ADHD population could be fixed environmentally, e.g. by just going to the damn gym? How much can be attributed to our modern lifestyles?
Structural differences in brain chemistry don't get fixed by going to the gym.
People with untreated ADHD are 3x more likely to be in a car accident. Going to the gym won't fix that.
50% of people with untreated ADHD have issues with substance abuse. 50%. Going to the gym won't help with that.
Divorce rates for people with ADHD are up to 2x population averages, a few hours a week lifting weights won't help with that.
> How much can be attributed to our modern lifestyles?
Risk factors for developing ADHD are heavily linked to exposure to the industrial pollutants that are a result from modern society. It isn't the largest factor, but it is a contributing one.
That is going to be the only "modern lifestyle" link you find.
People with ADHD don't just have problems sitting in a chair (that tends to go away as people age anyway), ADHD impacts emotional regulation, the ability to perceive time, and basically all other aspects of executive function.
ADHD isn't just "can't focus", that is just the most obvious symptom. ADHD is, aside from being horribly misnamed, a disorder of the executing functioning part of the brain that is responsible for controlling large swaths of higher order brain functions.
ADHD is both under and over diagnosed. It is under diagnosed in women, minorities, and people who are poor, and those facebook ads advertising 30 minute online questionnaire diagnoses are certainly pill mills, though I would also not call them a diagnosis.
Like most things in life, there isn't a simple yes or no answer.
> It is easier, less stressful and arguably more dignified buy illegal drugs on the black market.
I'd say that's a pretty clear sign they "fragile" supply chains is not the root cause. Somehow you can easily buy something that's had to be smuggled into the country in who knows what way, but not a legally manufactured product.
Smuggled drugs don't have to go through the byzantine bureaucracy of the DEA and myriad of other organizations. But that also means they don't have to go through any of those controls that actually ensure quality. As poorly as some of those controls seem to function, they are better than nothing.
I still think it's ironic that it's easier to get illegal drugs past an apparatus designed to stop block them, than to deliver legal drugs - that effectively the FDA is better at stopping drug trade than the DEA.
7 months is nothing. You’re in the honeymoon phase. Everyone with a recent adhd diagnosis thinks life is rainbows and butterflies but you’re on a stimulant drug. If you give someone cocaine daily they’ll tell you the same thing.
I’ve been on and off heavy stimulant meds since 2012. They only work for a short period of time. Dosage needs to go up. Consequences need to be managed. At some point you’ll hit a ceiling and they will no longer be effective. It’s just a matter of time.
Honeymoon phase on stimulant meds lasts days, weeks at most. Not 7 months, like you say here. I feel that, were GP to write that they've been on Vyvanse for two years, you'd call that "honeymoon phase" too.
Even if the meds would stop working entirely after couple of months, that couple of months of improved ability to function is a lot - enough to regain lost self-esteem, and introduce lifestyle changes that will remain even when the drugs are gone or no longer effective.
What are you talking about? I’ve been on the same dosage for over 12 years, and it is just as effective for me today as it was on day 1. Still waiting for those consequences I guess..
Are you coming across any habituation issues? I've been taking ritalin for a while (and it has made a huge difference in my life) but it does concern me that my dosage has been slowly increasing.
I take dexedrine (which is basically just what vyvanse turns into once you take it), and I have some tolerance after just 3 months.
Which is incredibly unfortunate, because my prescription started at 30mg/day because my body is just resistant to stimulants for some reason. Going any higher causes a hypertensive crisis, but tolerance is evil.
Why does homeostasis want me to have ADHD again? Wish someone could find the genetic crap that controls this and fix it.
My doc told me that the stimulant amd appetite suppressant properties would attenuate quickly, and they did, but that the effect on dopamine and epinephrine reuptake don't show the same down regulation over time. It seems like ahe was righ, a year and a half later I can't tell I'm on the atuff except I can start tasks I find boring. And remember meetings.
Well, the problem is that once tolerance builds, I become unable to stay up for the entire day. "The entire day" being from around 4 AM to 8 PM.
So my sleep schedule starts to get stupid again.
My current routine seems to work around this by re-fixing my sleep schedule every 3 days or so.
Before tolerance, I could wake up at 4AM without an alarm, stay up until 8PM or so, then sleep until 4AM the next day, and repeat that for a month or two. Good times. Internal clock actually worked and everything was running smoothly. Makes me wish I didn't require such a dangerously high dose.
Yes, meditation is extremely helpful to those who suffer from anxiety or ADHD. Daily meditation, on the order of 10-20 minutes at a time: that is a good goal.
Many who practice regular meditation find that they can subsequently live drug-free lifestyles, because drugs are a crutch for the body, but meditation is an enduring and efficacious cure for what ails the spirit.
> meditation is an enduring and efficacious cure for what ails the spirit
Meditation reduces the urge to actually use drugs to fix problems if you no longer perceive any problems to fix. It's just getting to this point that people have trouble with.
Accepting yourself and working within your flaws rather than trying to achieve perfection.
Do you feel that they make a difference, in terms of tolerance resets? I've tried going no/low-dose on the weekends in the past, but I found it made me feel kind of resentful that I was saving my 'good' time for work.
Yea it really does. I personally only need like 1 day every 2 weeks to reset to a good level…mind you, it never goes back to that euphoric beginning but that’s also ok.
To be totally transparent however, there are a lot of other things I do because I’ve learned that they contribute essentially to my medication working and I waited to respond to give you a full response.
Exercise is one. I don’t need a lot of it, I always try to get it done before taking medication that day and it’s a mix of long distance running and personal training. I know the latter is very expensive so if I had to recommend an alternative, I would say something like p90x is good. Great even. It’s almost a full hour of working out, full body, cardio mixed with weights, never very heavy either…you really feel like you did something afterwards.
Make sure to follow that up with a day at a lower dosage or no dosage if the medication is murdering your appetite. I think part of the rest medications don’t always work is honestly lack of glycogen from reduced appetite. Or the inability to use it? We’re entering bro science here for sure.
Besides breaks and exercise I find that some supplements work really well and become necessary to balance the whole experience out. A lot of people will recommend magnesium (glycinate for better absorption). I take it in the form of ZMA (with zinc), alongside it tyrosine seems to really help, fish oil, b complex (to make up for bad appetite) and recently added this other mixture of citrulline, arginine and dipotassium phosphate (6% dv/serving).
That last one is supposed to improve circulation and the potassium I find helps me relax. Takes the edge off of the medication.
Besides that, pay close attention to the side effects. Eating a big meal almost always has a positive effect on me. If I’m not thermoregulating well I look at circulation and exercise. I’ve been monitoring my blood glucose levels too and they seem ok throughout the day but sometimes I wake up at I get readings of 100 (forget the unit here, ng/dl?) so I’ll talk to my doctor about that.
Let me know if you have any questions about anything here. I’m more than happy to answer them. I know how hard it can be to take such an effective yet punishing medication.
I appreciate your response, and it's interesting to me that we've come to many of the same conclusions. Exercise has always felt good for me, but it became an absolutely necessity once I started taking ritalin. I took up rowing (it's a great full-body workout) and it's been a boon for my general health.
I also take magnesium (threonate, in my case), although I did that initially to help prevent migraines, along with fish oil, zinc & B vitamins.
I have not tried citrulline, arginine, or dipotassium phosphate. What benefits would you say those provide?
The citrulline, arginine + potassium is a recent thing I'm trying out. I'm getting good results from it in the form of lower anxiety. I had an experience with potassium from a trip to Mexico.
They have this drink there called electrolit and I remember it making me feel super relaxed, to the point where flying in turbulence didn't bother me anymore (I'm a nervous flyer). The only thing that stood out was its potassium content clocking in at 7% d/v in one bottle...really hard to get those kinds of numbers from even a potassium supplement, which come in at 1% per pill in the US. I guess it's because overdosing on it can potentially be fatal and slow down your heart too much? But for someone taking a stimulant it might be really good.
Then the citrulline/arginine is meant to help w/ vasodilation, which I think is hampered by the drugs and presents itself in the form of cold extremities. It's a lot of stuff to take just to be able to function but for me the difference is night and day. Off of it, I've been expelled from every school I've ever attended, on it, I've published half a dozen scientific papers and made a career for myself, so I'm never stopping.
Long term though, my goals are to eliminate or reduce my dosage and supplements by training to get my resting heart rate down a few points. It's what I'm working on with my personal trainer and so far it's been working.
One of the big problems with ADHD is usually that you can't complete personal goals and tasks because it's too much effort to switch to it. For example, hobby projects and such.
ADHD sort of... disagrees with you over what it finds worth doing versus what you want to do. It can make you feel like you're not in control of your own body, and that can lead to dysphoria and depression, or at the very least intrusive thoughts that you're not doing something that you should be.
For example, I've been working on an image upscaler for the past three weeks or so. Would I have been able to do that without my meds? Probably not. I will probably even end up finishing it soon.
While I'm writing this comment (and indeed, while I hung out on HN all day today) I've been thinking of the work I'm not doing and then just... being okay with it, because I'm on my meds and I know I'll be able to get to it.
I've even been making little steps throughout the day whenever I felt like a moment, but I'm not afraid to take breaks or do what I enjoy at the moment, because I know I have a choice.
If I weren't on my meds... it'd be a different story. I'd be at the mercy of whatever my ADHD felt was worth doing, and it'd feel a lot less reassuring.
Being medicated during leisure time is important, too.
I have not increased dosage beyond the 30mg they gave me at the start. Every month I try to take 3 days off. I make sure to always take it at the same time every day and I try to sleep as best I can and eat at the same time every day.
Yeah ive done the research. I just take the starting dose once in the morning every day and i take 3 days off a month. Im not binge eating and im not yoyo dieting anymore. All the dopamine seeking habits i had of gambling and playing video games are gone. I get 8 hours of sleep every night, i eat three meals a day.
Everyone i know that had to stop ended up abusing it. They took it at night to study or party. They took an extra dose if they needed to work extra hard.
Im not going to go up in dose so i have no reason to think my experience now will change in 5 years
> In all honesty it is truly no different than being an alcoholic or a crack addict.
It's different because you aren't going to end up incarcerated and made a felon with drug convictions on your record for taking your medicine. Your dose is theoretically metered so that you can't exactly abuse it to the point where you're shooting it or taking absurd psychosis triggering doses. Theoretically, your doctor will prevent you from taking higher doses just to get high as your tolerance to it builds up over time. It has the potential to be a much less life ruining/ending situation.
My dosage is 25mg of Adderall XR per day. Not only can you not shoot up with it, the fact that it's extended release really puts a damper on how high you can get on it. I honestly doubt an addict would get much out of taking my entire month's prescription all at once.
If it was the instant release pills instead of extended release capsules, then, maybe they could get a couple good highs out of it. But the point is that you're right: I'm not prescribed enough to even get addicted, much less sustain an addiction.
If someone took your entire month's prescription at once, they'd likely overdose (though you said addict, and it's likely they'd have a much higher tolerance)
IIRC you can crush up the adderall XR and insufflate it, so I imagine you could shoot it as well
> IIRC you can crush up the adderall XR and insufflate it, so I imagine you could shoot it as well
You can shoot anything, but unless you're really careful and spend the time with "proper" technique, filters, etc, shooting pill binders is the fast lane to serious heart damage.
If you're at the point where you're considering shooting pills, you are also probably making other desperate decisions that don't involve proper technique, filters, etc.
The real proper technique is never injecting pills in the first place.
I quit taking non-prescrip Adderall at the start of the year after having taken it for ~7 months and am so happy I did!
I'm friendlier, my thought process is more clear and less scattered, I don't surprise people with chatty behavior some of the day and then ghost them other times of the day, and I'm more aware of my overall health and energy levels. If I stop running, lifting weights, eating a really clean diet, sleeping restfully, or start smoking/drinking - I feel it now and there's no hiding from it. While on Adderall, all of my bad health habits were just a slight adjustment to a dosage away from being a non-issue for another month, but the downward health spiral from ignoring all the extra care I could be doing for myself really started adding up.
Looking back at that time, I really thought I was being hyper productive while on it, but I think it was more like I was spinning my wheels really fast, not going very far, and feeling unreasonably good about the progress I was making because all my brain's reward centers were constantly firing. I could do an endless amount of simple work, and actively sought out that type of work, but the real deep critical thinking stuff I started to balk at and look for ways to justify avoiding - usually by doing double or triple the amount of simple stuff. It's odd that it made me feel so dang confident in my abilities.
No hate to those who have ADHD and take it, but, for me who was taking it illicitly at low dosages (1mg-5mg), all the negative side-effects drastically outweighed the benefits and I only really saw that once I found it inside me to stop.
Definitely sucks having to re-train my willpower though. It was just so damn easy to delegate all of that to the drug. It took a few months before I felt I could really convince my brain to work hard on its own, but now I'm back!
Good luck and best wishes to all those out there that see a bit of themselves in this post :)
One of the worst parts of the experience is no one can quite put a finger on what's changed. With Ritalin and several other psychiatric drug, people can tell when someone is turning into a zombie and their feedback can help auto correct. With adderall, that doesn't really happen until one is downright manic.
Yup! At the start everyone just thought I was slaying the game, then everyone just thought I was really busy, then everyone just thought I was getting stressed out from how busy I was, and only after all of that did people start casually bringing up the word Adderall in conversations and let me come to my own realizations that my behavioral changes were more apparent than I'd realized. Nice to have friends willing to take that step, though.
I've never taken it but from what I read about recommended doses, 1-5mg per day for an adult is basically placebo effect. I'm not saying you didn't feel all those things, but this seems too low for it to cause you any effects such as these, moreover after months of usage.
> If I stop running, lifting weights, eating a really clean diet, sleeping restfully, or start smoking/drinking - I feel it now and there's no hiding from it.
No offense, but alternative read of this is: you're probably spending a huge part of your life on coping mechanisms for a problem that can be better corrected with a pill.
It's either that, or you're one of those legendary superhumans I keep hearing about on the Internet, who can simultaneously run, hike, hit the gym every other day, home-cook meals or otherwise obsess about "healthy eating" and fitness, and then also hold a full-time job, have a spouse and children, run a side hustle, volunteer in the community, drive kids to soccer matches and still sleep 8 hours a day.
> I'm friendlier, my thought process is more clear and less scattered
What the actual fuck.
If you are friendlier off amphetamine, either you don't have ADHD or you're taking way too much, dude.
If you have scattered thoughts on amphetamine, either you don't have ADHD or you're taking way too much, dude.
--
Comments like this makes me furious. Because of misdiagnosis, or inept psychiatrists, y'all keep making the life of actual people with correctly dosed ADHD medication hell with your abuse or repeating the same story that it makes you robotic and makes you jump of the wall.
I have been 35 years unmedicated, I am on the same dosage for a year, with routine 2 or 3 days long breaks. On days off, I am perhaps a little more lazy, but as scatter brained, as slow, as tired and as unmotivated as I have been my entire life.
When I am medicated, on the least effective dose, because that is how titration should work, my mind is silent. I am more attentive to people, more patient, there is space to think and to plan. When I am medicated, I go to bed proud of what I have accomplished today. This small thing has turned my bloody life and mental health the right side up.
Jesus, every time there is an ADHD post on this forum the misinformation and ignorance around a very well researched medication abounds. It has taken me 35 years to know there was a solution to the mismatch between what I thought I could do and what I did, because of posts like this, saying ADHD meds makes you scatter brained, it is very addictive, it is hard to quit, it is ineffective, etc.
I'm sorry that me sharing my experience left you feeling furious. It was not my intent.
I did not claim to have an ADHD diagnosis. I stated I was taking off-prescription and shared the dosage - well below a typical adult prescription amount. It's entirely possible I do not have ADHD, but I did see significant benefits, the ones you describe like a silent mind, attentiveness, patience, for a period of time. Then those things faded away, I stopped taking, and experienced side-effects as my body normalized to not taking.
Is there a way I could've shared my story that would've been less upsetting?
> I did see significant benefits, the ones you describe like a silent mind, attentiveness, patience, for a period of time. Then those things faded away, I stopped taking, and experienced side-effects as my body normalized to not taking.
This is exactly how someone without ADHD is affected by Adderall. The medication has two functions: increased alertness and focus, which you build a tolerance to, and improved executive control, which is only relevant for folks with ADHD, and your body generally doesn't build a tolerance to.
I found myself being a bit more snappy than usual when interrupted while working on something. I attribute that to my ability to actually focus for once and I resented it when people were taking that away. Unmedicated I’m quite happy to play along with all the distractions people bring my way.
I have been plagued by issue after issue with getting my prescription filled correctly (dosage, timing, and shortages). I would prefer to come off of it completely, but my doctor has even managed to make that difficult.
Any tips for just going cold turkey? I can't wait any longer for my psychiatrist to prescribe an alternative.
If you’re talking about adhd drugs like adderall then how do you deal with untreated adhd? It’s absolutely exhausting to me and maddening to everyone around me when I have to go without for whatever reason.
There is no good answer. Adderall is a miracle drug for people like us.
To get by without, you have two options: incredible discipline and force of will, and overcompensating with other stimulants.
Meditate, exercise, do anything it takes to force yourself into whatever structure fits your life. I'm talking to-do lists for your to-do lists and scheduling your daily time down to brushing your teeth. You have to force structure onto your life to contain your attention and energy. You have to make some truly profound changes in your life.
Or drink way too much caffeine, smoke too many cigarettes and try very hard to not think about the damage you're doing.
The only shortcut I know of is to get enough black market adderall for a couple of months and use that to keep yourself functional long enough to build the systems and habits that can keep you going without.
See the Getting Things Done method, pomodoro, and find a good task management system. Write everything down, find a system for keeping notes. Also try keeping a diary.
Also try to reduce your phone and computer usage. If your phone supports it, use monochrome mode. Push yourself to read more books instead of watching videos or playing games.
I thrived without meds during my time in the Army. The structure, being told what to wear, when to show up, and the clearly defined expectations were great.
Attempting to emulate this personally as a civilian has yielded mixed results.
The market is ripe for a First Sergeant as Service solution.
> Attempting to emulate this personally as a civilian has yielded mixed results.
Right. I'm not even trying, even though I highly suspect it would've helped me if it worked - because I know it won't, because my brain is able to tell when I'm trying to trick it, and will refuse to cooperate.
Actual military? That could work, because the order and structure would be beyond my control. Self-imposed? It's hard enough on drugs, impossible without. Asking someone else to impose some structure on me, as an adult? My brain knows it's even easier to cancel the deal, weasel off of the agreement - especially if it has literally no other purpose and meaning than trying to trick myself into functioning.
So yeah, I'd be up for becoming a paying customer of some First Seregant as a Service thing, but I can't imagine how you could structure it so it doesn't feel artificial and voluntary, making me unable to stick to it any more that I can to exercising (a highly beneficial activity that my brain recognizes as artificial and bullshit, and refuses to allow it).
I'd say this is where there is a whole area of non-sexual Dom/Sub dynamic kink relationships. It exists, just has a taboo attached to it and is also difficult to find and negotiate.
That's... something so unusual that it never would've occurred to me. Thanks for posting it!
When you put it this way, I think you're absolutely right about this - those kinks are exactly what one should expect to have a "halo" around them, of people unknowingly self-medicating their undiagnosed ADHD.
YMMV, but this has been great for a "natural" feeling focus for myself as someone with ADHD.
2 pills of BodyBio PC (phosphatidylcholine + 3 other phospholipids)
3g MSM
1g DHA
140mg elemental Magnesium Threonate
Optionally:
1g Taurine + 100mg caffiene pill
Another optionally
50mg provigil/modafinil (typical dose is 200mg)
=============
Most folks are focusing on dopamine increasers (amphetamines, provigil, dopa mucuna, caffiene, sugar) as dopamine stimulants, but too much has its rough points as others have pointed out.
But focusing on supplying underlying nutrition has had pretty profound effects on my mental ability to get things done and focus.
> Meditate, exercise, do anything it takes to force yourself into whatever structure fits your life. I'm talking to-do lists for your to-do lists and scheduling your daily time down to brushing your teeth. You have to force structure onto your life to contain your attention and energy. You have to make some truly profound changes in your life.
This doesn't help when I try to get out of bed in the morning and my body does not move. Does not move. I can't do it.
I'm not going to tell you that happy thoughts and a motivational poster will fix you. I will say that once you get past the stage you're in and have the ability to make those big life changes, this part will happen less often and you'll find it easier to break through. When you're generally healthy, it's easier to recover when you're sick. Applies just the same to mental illness as it does to an infection.
Unfortunately, you're in the hardest part. Or at least it feels that way in the moment. I don't have any good advice other than to seek help and do whatever gets you to the next day. Try your best to make small improvements when you can. It is okay to not make progress every day, but you also have to not let that be an excuse. You really have to push yourself. It might be the hardest thing you'll ever do, but you aren't the first to have done it.
Sorry all I have is the same pithy nonsense you get on Facebook. At the core, it's good advice, but you have to know the limits. There are some battles you can't fight. Sometimes you are in a truly impossible situation. No internet comment can help you with that, but you can find help if you can bring yourself to ask for it.
> I don't have any good advice other than to seek help and do whatever gets you to the next day.
Well... I did seek help, and ended up on dextroamphetamine, which helps me more than any routine possibly could. It's just that my tolerance got bad enough in just 3 months that now I can't take it more than once every few days, or else it completely stops working.
I can't take more because my body already requires a dangerously high dose (30mg/day) and raising it any further causes heart issues. (I tried)
I'm also on dextroamphetamine and have been for ~10 years now, with some breaks. When I get off it, I always make sure to taper down the dose. Otherwise I'll be miserable for no reason. I also skip doses on the weekends, which gives me body a chance to reset and keeps the tolerance cliff from growing higher every week. It does come with the tradeoff of sleeping most of the weekend, but if my body needs it, then who am I to say no?
Regarding inability to get out of bed: I empathize completely and have been there, even while on medication. There's not really a magic solution, but if you are getting off medication, you just need to give it time and eventually (could be months) your dopamine levels will return to normal.
Also, I think it's important to recognize the difference between motivation and willpower. If you have ADHD, I'm probably preaching to the choir here. But for me, "motivation" is a long term drive more akin to ambition, whereas willpower is a short term muscle that I have trouble exercising. That's what makes ADHD so frustrating: I have an abundance of ambition and motivation, but a dearth of willpower. I know what I should be doing, but I just can't do it. This is a distinction that someone suffering from ADHD will recognize immediately, but a neurotypical person can only understand in the abstract, if at all.
Getting out of bed is about willpower, but it can also be about motivation - it's worth examining your life trajectory to see if you're moving in a direction you're happy with, because if the cause is lack of motivation, then pills will hardly help (other than a desire to take them driving you to get out of bed). Pills can fix a lack of willpower, but no pharmaceutical can give you motivation. That's a long term drive that you need to seek for yourself.
I don't, that's why I keep taking them... but I've had periods of time where I lived abroad or didn't have easy access to the medication, so I had to taper off it. It definitely sucks, and especially after you stop using it, you'll feel especially slow and groggy. You'll also gain a lot of weight. But after a few months you'll feel pretty "normal," at the cost of having all your ADHD symptoms return.
Ughh... It's all too familiar unfortunately. I've gone without my meds for a week or two on occasion over the past year.
I was hoping for "this one weird trick" life hack silver bullet to save the day.
My wife and I are expecting our first child later this year. It's becoming apparent the only way to minimize my reliance on a capricious and inconstant system is to pull off the bandaid now and chart my path out of these woods.
Just curious, is there a risk associated to stopping cold turkey? Every time I stop stimulants cold turkey I just sleep for 15 hours or so and then I'm fine. Maybe there are side effects I just don't get.
I went cold turkey after a couple years of consist medication because I missed an appointment due to being sick and wasn’t able to get it rescheduled until I was unmedicated again. By that point I was back in the rut of useless executive function. Surprisingly I had zero issues just stopping taking it. Obviously the executive dysfunction came back quickly but I had zero withdrawal symptoms dropping 30mg XR. Maybe I was just lucky.
What about non-stimulant drugs? Are they as difficult to get? I'm bipolar, so stimulant drugs are not a great idea for me, but I'd still like to get some help. My experience has shown it's not something I can meditate/diet/exercise my way out of.
Guanfacine is one non stimulant ADHD prescribed med that you might want to look into. For OTC supplements I don't think it hurts to consider N-Aceytl-cysteine (NAC) but it's not a cure all.
Straterra is an option but I believe works like an anti-depressant. My experience wasn't great with it, but who knows? If it works for you that's great!
Be careful with SSRIs, they can be neurotoxic over the long term (as in 2+ years). I can't find a good paper from a quick Google search, but if you use SSRIs for long enough they can start to damage serotonin receptors, and you might develop a permanent tolerance to serotonin. Somewhat similar to meth's neurotoxicity to dopamine receptors.
SNRIs are even worse. I've by random chance met two people who got permanent movement disorders from Venlafaxine, and one who developed seizures. My own experience was extremely abysmal too. All of the side effects of stimulants ramped up to 11 with none of the benefits.
Oh, whoops. I probably skimmed the page too fast or something. Not aware of anything bad with norepinephrine, although my specific case of ADHD gets much worse with SNRIs or levoamphetamine so obviously YMMV.
No it’s not. It’s the truth. If you can’t exist without a substance that is being controlled by an elaborate chain of pharmaceutical companies, federal drug enforcement regulations and highly expensive doctors that is being up shit creek without a paddle.
What would you do if something like WWIII started and all non-vital drug manufacturing stopped? Or any conceivable scenario where suddenly these meds are not available. Everything is more fragile than you realize. Look at baby formula or other products that are produced by literally one single supplier. The system works until it doesn’t.
So let’s pretend adhd meds cease to exist. What will you do? Give up on life and cry about it? You need to be prepared for any circumstance.
Don’t get me wrong I’m struggling and I miss it constantly but I’ve also had to reset my mindset and expectations. People tend to adopt adhd as an identity but it’s not something that should be done. We all struggle to varying degrees with executive dysfunction and it’s silly to hide behind this crutch. Outside this high paced world people with adhd are just fine. But in this environment they are “disabled”
Holy shit that was brutal, more brutal than it had any right to be.
No, it's not fair to equate people treating their ADHD to crack addicts. Because treating ADHD and being addicted to crack are two different things.
People treating their ADHD have an actual physical deficiency in their brain that takes away capacity to function, and this is a disability, no matter what term you do or do not use for it in "this high paced world".
Usage of ADHD medication to address that deficiency is not at all the same as crack addiction. Because crack addiction is not addressing a deficiency, it's trying to add recreational pleasure to a perfectly normal and functional brain.
ADHD medication is trying to avoid the executive dysfunction that ADHD causes. Which no, is not something that "we all struggle to varying degrees" with; ADHD is worse. For example my body literally will not move if I try to do something that I don't want to do. Even if it's something that I need to do, or something that will have dire consequences if I don't. I won't be able to move, even if I try. The signals just do not reach the rest of my brain.
People with ADHD cannot just suck it up. They can't. You are being incredibly disrespectful and undermining a legitimate disability by acting like being dependent on ADHD medication is anything like being addicted to crack.
If you can suck it up and live without it, fine, good for you. If you can just change your lifestyle to work around your ADHD, fine. But not everybody can do this. And it's not their fault if they can't. It's not their fault that they were born with a brain that is not working as it should. And it's not their fault for wanting to fix it.
People who treat their ADHD don't want euphoria or pleasure or a fun time. They just want to live their fucking life without suffering from boredom and executive dysfunction and all the involuntary coping mechanisms that ADHD promotes.
Keep your incredibly insulting views to yourself. Comments like this help no one.
You were born with a damaged brain. I'm very sorry, I was too. It sucks. If World War III starts tomorrow, you're right, I'm going to have problems. But a lot of people are going to have very many problems in that case. But World war III isn't going to start tomorrow, and catastrophizing about it doesn't help matters. It's not going to, but let's say it did, there's still all of the already manufactured drug sitting in factory, sitting in semi-trucks and cargo containers on ships and on pharmacy shelves. The enemy (whomever this theoretical enemy is) isn't going to target Adderall factories and semi-trucks with their guided missiles, and even if they did, you've still got the rest of this month's supply, so it's still not instantly a problem.
We've got the mental equivalent of a person born missing their legs, so we need a wheelchair for the mind. With mind wheelchairs to make up for our missing executive function and other deficits, we can even sometimes outperform neurotypicals, but without it we're crawling on the ground with no legs. But having the wheelchair to use is so much better than crawling around on the ground.
Now that we've found this wheelchair that enables me to have a job and a life that I actually want, I'm not going to throw it away just because someone could come along and steal it. That's mental!
It's a lie that people with adhd are fine outside of our fast paced world. Can you imagine being a farmer with no executive function? How are you going plan ahead to grow crops so you don't starve over the winter. Can you imagine trying to plan a woolly mammoth hunt? Just how do you plan on killing the thing without executive function? Our brains would just be Step 1. Find woolly mammoth. Step 6. Eat woolly mammoth meat. You don't get to step 6 without figuring out the missing steps!
We're not the only ones in this boat, and it sucks to be disabled, but we don't have the technology to fix our brains, so we just have to accept it. Just like those with hypertension have to live with needing heart medication, or diabetics need insulin, or rheumatoid arthritis sufferers need their DMARDs, or AIDs patients need their ARTs, or epileptics need their anti-seizure medication, or hypothyroidism sufferers need their synthetic thyroid medication.
Hell, if gasoline magically disappeared, society would be fucked. Not sure if anyone is prepared for that circumstance. Because it's ludicrous. The world's gasoline won't magically disappear in an instant. Stop watching so many movies.
> If World War III starts tomorrow, you're right, I'm going to have problems.
I don’t know. Chaotic environments seem to be where my ADHD mind operates best when not on medication. I’m by far at my most productive when shit is on fire and everyone is panicking and doesn’t know what to do. I don’t think most ADHD folks would need medication if it wasn’t for modern working environments. When I’m dragged into WW3, my inability to pay bills on time or my complete lack of ability to start putting together that architecture until the deadline is looming will no longer be my greatest weaknesses.
Don't get me wrong, I'm right there with you! My career as an on-call SRE dealing with incident response wasn't chosen by accident. If the website's on fire, suddenly I can move mountains, but if I have the luxury of waiting until 9 am Monday morning to do the exact same tasks, my brain just won't cooperate.
It's easy to frame the demands of modern working environments as the problem, but it's really the other way around. Modern society is so luxurious, so privileged, there's just so much excess, that bills don't rise to the level of emergency that my lizard brain is able to comprehend. Consciously, yes, I need to pay my bills, but it's nothing bad happens immediately the instant my power bill is late. Even when the power company does send somebody out, they don't ring my doorbell and start yelling at me for not paying. If someone I didn't know came by and yelled at me I'd be way more able to remember to pay my bill. (SYayaS? Stranger yelling at you as a service?) But that's rude and unpleasant and no one wants that.
Meanwhile, outside the trappings of modern society, you don't have a plan for catching the woolly mammoth until you're too hungry to think, and then you can't think (not that you were great at planning to begin with) so you starve and die.
This whole "it's modern society that's the problem with my ADHD" is a stupid myth that needs to die.
> Meanwhile, outside the trappings of modern society, you don't have a plan for catching the woolly mammoth until you're too hungry to think, and then you can't think (not that you were great at planning to begin with) so you starve and die.
I also wouldn't have thousands of completely meaningless distractions. It's not like the choice was doom scroll Twitter or go hunt that woolly mammoth. You also get hungry long before your body falls apart due to starvation. I can't imagine anyone's ADHD making them lay around until their body was too emaciated to hunt. If the tribe is unsure of how to take out a woolly mammoth, that sounds like the sort of problem I'd (involuntarily) ideate on instead of twisting all that cordage. For me to accept this as a myth, I'd need something far more compelling.
We need to stop offering tax deductions for advertising and offer tax deductions for maintaining inventory. We are squeezing all of the safety margins out of our entire economy because that's what the beancounters tell us to do.
The drugs that have shortages are almost always generics. Those companies don't advertise, they run on razor thin margins - which is exactly why you have shortages because these companies will often just stop making a drug if it's not profitable.
Maybe we should take a page from farm subsidies and have pharmaceutical subsidies where the government will buy some quantity of expired inventory of important medicines. Price it at kind of the low end of what insurance companies would pay the pharmaceutical company, so they'd rather sell it to a consumer, but they can still make money on the government planned over supply.
No deduction. Just a law. If you want the regulatory privilege of providing important medications to the public, you must be able to continue to provide said medications during supply issues for national security purposes.
So that would have to be something contingent on FDA approval for your factory? I could see that.
I would also expand that to include any drugs that require a tapering off period should require an emergency supply as well. We can't have people keeling over from methadone withdrawals because you decided to piss off your only vendor.
In fact I might go so far as to say that you can't institute a price hike without a grace period either, which may or may not include one final prescription renewal at the old price.
Price hikes got a bad rap because of a few egregious examples, but they've been responsible for shortages, too.
I'm an anesthesiologist. Almost all of our drugs are generic. But there have been shortages of one or another for most of the last 15 years. Why? Among other things, the federal government limited price hikes to a percentage per quarter that Medicare and Medicaid would pay (gross oversimplification, but close enough).
This sounds like a great idea. But when you can't do a 100% price hike on a drug that sells for 40 cents per ampule, you can't pay overtime and do increased-tempo maintenance to keep a line running almost 24/7. So if one generic manufacturer quits making a drug that only has 2-3 sources, the others simply can't fill in the gap. Sometimes they stop making it because it's no longer profitable, sometimes because other factors (failing to pass an inspection, e.g.) cause a temporary shutdown. But if you can't double the price of a dirt-cheap drug, you often can't double your output (because the drug is cheap - it's the labor, packaging, and regulatory compliance that are expensive, and they scale per dose, not per kg made).
This is a very different world from the famous cases you see in newspapers about huge increases in price for medications that have been generic for a long time, but it is there and it really does hit us.
The comments in this thread regarding illegal or casual use of adderall or other amphetamines without an underlying condition are really disheartening. In the USA it is already excessively difficult for those suffering from ADHD to get a diagnosis, find medication that works and maintain a ready supply without a buffer. Abusers are contributing to the environment worsening for those who need these drugs.
These drugs can literally save lives from chaos and tragic ends. If these drugs help you live a more normal life, you are not an addict or an abuser.
The cosmic tragedy here is that this type of medication is practically impossible to become dependent on if you have ADHD. If anything the problem is usually remembering to even take the medication. I fear that abuse will hamstring any efforts to lift production limits.
It's very easy to get a prescription for ADHD meds in the USA, that is why Americans often struggle when they go abroad to Europe or other places to find doctors willing to prescribe them.
I had to get caps with timers on them to let me know if I took it that morning or not. In addition, I forget to renew & pickup my prescription almost every month.
> The cosmic tragedy here is that this type of medication is practically impossible to become dependent on if you have ADHD. If anything the problem is usually remembering to even take the medication.
Not necessarily... in fact, the hope of knowing it could solve everything made it possible for me to work through the stupid medical system in the first place. And now that I have it, and know it definitely works for me, I don't think I could ever forget to take it.
Hey. I'd love to talk to you more about this if you're willing? I have to assume your comment is in reference to my post. I apologize for saying something that upset you - it certainly was not my intent.
My perspective on this is:
- The process for getting prescribed Adderall is not objective. One is allowed to see multiple specialists and continue searching until one's perspective is seen and respected. Yes, there are objective differences in the brain, but brain scans aren't being used as the basis for issuing prescriptions.
- Adderall, like all drugs, comes with a set of benefits and drawbacks. It's up to the user to decide if those are resulting in a net positive and they are allowed to change their mind at any time. So, it's reasonable to believe that someone who is undiagnosed may still either be, or believe they are, benefiting from the drug - and then change their mind later. Changing their mind does not mean that they retroactively become an abuser.
- I would like a source for "practically impossible to become dependent if you have ADHD." There are plenty of studies that show addiction does not occur with statistical significance in those with ADHD + monitoring, but addiction is not the same as dependence. Dependence is implicit after continuous use, but, depending on baseline brain chemistry, different people revert to different baselines after discontinuation.
- I feel your concern is more with the U.S. war on drugs in general - not specific users. I believe you want everyone who may benefit from stimulants to be able to find out if they benefit from them as easily as possible. The path to this is legalization - not stricter enforcement.
On a more personal note, I have several friends who, by all external appearances, were doing just fine mentally, but did not make their physical health a priority. They got masters degrees, bought houses, held down solid white collar jobs. As we aged, continually ignoring their physical fitness and diet resulted in their bodies operating less efficiently, which began impacting their work, and so they sought legal help - and got it. Their personalities have now shifted to ones where they are always talking about their stimulants and how life is harder for them due to their diagnosis, but they still do not care for their bodies. They constantly search for the right dosage to make them magically better and become defensive when it's suggested that best results are achieved with both medical support and prioritization of personal health. It's really challenging for me to be supportive of this sort of behavior because I do not feel they are giving their bodies a fighting chance. I am now able to empathize with this mindset more fully having taken stimulants for a period of time. I felt firsthand how easy it was to ignore my health when there was a guaranteed window of time each day where I was able to live life fully attentive and stimulated.
I feel that it is entirely possible that I have ADHD. I have some neurodivergent tendencies, but I see myself as strong, independent, successful, and not the sort of person who is interested in convincing a medical professional to greenlight my behavior. So, I researched and explored for myself, thought that stimulant use was potentially beneficial for a period of time, and then changed my mind when I reflected on the actual results. Was it illegal? Yes. Does that make it implicitly morally unjust? I don't feel that way. I felt morally worse convincing a doctor to prescribe me medical marijuana when California was still in the process of legalizing it recreationally even though the symptoms I stated, such as trouble falling asleep, were valid and "prescription worthy." Of course, you're fully entitled to see things differently, but it was important to me to fully share my perspective since I felt what I said prior was upsetting.
Instead of telling all this to a stranger on the internet, tell this to your doctor. Look this may sound weird but if your doctor can prescribe you medicine for an underlying medical condition without determining if you have that underlying medical condition then there is a good chance they can assist in determining whether or not you have an underlying medical condition.
> Drug shortages and the quality problems that often cause them aren't limited to generic products, as evidenced by ongoing shortages of Adderall, Wegovy, Pluvicto, and others.
These aren't very good examples.
2 of those are relatively new drugs, 1 with runaway demand (Wegovy has the same ingredient as Ozempic) and the other, Pluvicto is a radiopharmaceutical with a short shelf life (so any manufacturing problems have immediate effects).
DEA regulations regulate how much amphetamine can be manufactured for production of Adderall, along with 30 day script limits, so there's not going to be a lot of slack in the distribution system, nor in patient's pill bottles.
Oh so it’s not just Canada that does silly stuff like this. My doctor has to remember to write “300 pills dispensed 60 at a time” rather than “5 repeats” or else I have to go waste his time for refills.
At least in Minnesota, my doctor can’t even do that. I need to contact him every time. I take three different controlled substances, one needs to be refilled monthly and the others are somewhere between 1-3 months each. It’s a mess and I feel like I’m bugging him every time. They’re busy enough without BS like that bogging them down.
Congratulations, America. You have re-created the Soviet economy. All of the problems of centralized planning & production, and with none of the benefits.
FDA drug approval should include a clause that requires a certain production rate per quarter along with an ongoing adjustment based on the number of prescriptions.
If the applicant misses the production rate for one quarter, they agree to work with a second source drug producer to prepare for production. If they miss the next quarter's quota, the second source is allowed to sell the drug for no less than three years.
It takes a long time to move production facilities.
Even if the original company decides to move production to another facility, it can take 6-12 months to run test batches, tests and submit it all to the FDA for approval.
I’m not sure drug companies need much incentive to not have supply issues. That’s lost sales.
If you dig into the actual causes it’s usually because of DEA limits (Adderal) or massive off-label use (Wegovy) or the fact that the drug is generic and the margins as so small nobody is all that interested in selling it.
Care to elaborate? Supply problems don’t strike me as FUD, but market failures. They might be correctable, with the correct incentives, but they’re still a problem.
Cut the FDA requirement and drug patents and I will get you higher quality drugs manufactured with full supply chain provenance for cheaper. The biggest secret is that getting on the good side of the FDA is about knowing people and all that usual shit.
Americans choose shortages because they think bureaucracy gets them quality. Instead what it gets them is a lack of baby formula and military planes importing it from Europe (presumably only the few cans that would cause children to not instantaneously drop dead like they do in Europe where they don't put FDA labels on them).
People like to argue about what the proximate cause is of drug shortages. Or for that matter why we can’t build affordable housing or provide healthcare for everyone, or keep people from shooting up shopping malls.
Honestly, I don’t care about the details of each individual problem, which are complicated and ultimately unenlightening. The big picture answer is this: America is becoming a failed state.
Generally that happens because a small group of economic and political elites get too much power, and their interests begin to conflict with the interests of the general population. That’s the big picture. It’s just not in the narrow short term interests of the ruling class to actually solve these problems. And as long as that remains true, they will continue to get worse.
Since most drugs are the product of public research that then gets gobbled up and privatized by the pharmaceutical industry, we should just build out state capacity for their manufacture. Taking this one step further, we could even had a national healthcare system that monitors utilization and adjusts production accordingly!
Pre-Corona-destabilization, and pre-Trump, I wouldn't agree with you, but I do now; especially since we are in the middle of the Opioid crisis.
The government can and will seize patents at will. Only a handful of people need to be "convinced" to share their knowledge on production, and there are enough laws and spying that anyone can be "convinced".
If a hard left president of the US decided the US wanted to produce drugs, it would produce drugs and that would be the end of it. If children start dying because of drug shortages, this will happen.
Coming from the materials technology arena, those solutions wouldn’t have been available day one if it came out of a government led lab. Government research has no means to pay for the extra effort and talent required to get things done quickly. Also, committee led research can float off into random areas with little applicability this century.
Most drugs are the product of private pharmaceutical companies conducting extremely expensive phase 3 clinical trials. The government sponsored research is a relatively small component of the full cost of bringing a new drug to market.
It's illegal. Not that it would stop everyone, but a lot of people who DIY won't go there. They will do other projects. And if they are going to illegally DIY drugs to make money then they will make other ones instead.
The Wegovy shortage is because it was recently approved to treat obesity. The number of new prescriptions was larger than Novo Nordisk predicted, so they're still ramping up production.
1. https://www.federalregister.gov/documents/2021/12/02/2021-26...
2. https://www.federalregister.gov/documents/2022/12/02/2022-26...