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ADHD drug treatment and risk of negative events and outcomes

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Re: ADHD drug treatment and risk of negative events and outcomes

#181

Post by 1659447091 »

hombre_fatal wrote: post #137
SubmarineClub wrote: post #82

Earlier quoted context omitted.

Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.

I was on a 90 day prescription for ten years (vyvanse) when I told my doctor I was traveling abroad. Insurance doesn’t cover 90 day bottles so it was $300/mo but worth it. Nowadays there’s generic Vyvanse which is much cheaper so it probably makes 90 day prescriptions financially viable? I just moved back to the US and had to find a new local doctor who gives me 30 day scripts so I haven’t asked about 90 day yet. I i…

> I just moved back to the US and had to find a new local doctor who gives me 30 day scripts

You may have difficultly getting a 90 day, both the doc and pharmacist have to agree to do it - 3x30 day with 'fill on dates' is more likely.

When I had a long out of town trip I was able to get a 60 day script. When I came back the doc sent 60 day script again but the pharmacist wouldn't fill it and only allowed it because what ever code/note the doc added about long term travel. That was self pay so I wasn't even a risk for selling it. Some states won't allow more than 3x30 day.

I am surprised you got name brand vyvanse for $300/month, generic is ~$250/month without coupons/discount cards

Re: ADHD drug treatment and risk of negative events and outcomes

#182

Post by arcfour »

Spooky23 wrote: post #106
arcfour wrote: post #92

Earlier quoted context omitted.

What does the DEA have to do with US health insurance, exactly?

They issue licenses for making the drugs and getting the raw materials to make them. The process is inflexible at best and if manufacturer A hits their quota, they can’t get additional raw materials, even if manufacturer B has excess. Like most things associated with drug criminality, the rules are stupid and capricious.

And this has nothing to do with insurance, but does have to do with government bureaucracy negatively impacting people getting treatment for an illness.

Re: ADHD drug treatment and risk of negative events and outcomes

#183

Post by qingcharles »

0cf8612b2e1e wrote: post #153
SubmarineClub wrote: post #82

Earlier quoted context omitted.

Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.

Not to make light of your situation, but women taking birth control have been in this situation forever. It is only recently that over the counter birth control and/or three month allotments have been available.

* In the USA

Re: ADHD drug treatment and risk of negative events and outcomes

#184

Post by hinkley »

baby_souffle wrote: post #144
hinkley wrote: post #107

Earlier quoted context omitted.

I've heard it argued that ADHD diagnoses should come with a social worker. Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst. One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a dra…

> I've heard it argued that ADHD diagnoses should come with a social worker. I know a few people with crippling ADHD that have managed to hire a "life coach" of sorts to help. Takes a bit of screening to find somebody that knows ADHD and how to help with it versus the more generic/useless skills you probably first thought of when you read 'life coach' :). > Every time I realize it's Friday and I'm gonna run out of me…

Oh yeah, and I didn’t even cover the problem of “I have eight pills left and want to go out of town for two weeks”. They will not let you refill scheduled substances ahead of time like that.

Re: ADHD drug treatment and risk of negative events and outcomes

#185

Post by mandevil »

mithametacs wrote: post #101
klipklop wrote: post #77

The irony about getting treatment for ADHD is that medical providers make it very hard to get the proper medication and treatment. People with ADHD are horrible at following through and handle rejection poorly. So the worse the ADHD is, the less likely somebody will be able to actually get treatment for it. A lot of people suffer because doctors fear losing their license like so many did during the pain pill debacle.…

I literally did the thing you’re not supposed to do. my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her. Then I just told my psychiatrist that I have Adderall prescription and she took it over. For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Me…

The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it. This is a response to the problems with the abuse of legal opiates a decade ago- the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.

Your psychiatrist is trying to deal with the DEA monitoring, and doesn't want to be the one who first puts you on it, but continuing an existing Rx is not treated the same by the DEA, as I understand it. So the online doc is putting her license more at risk to a DEA investigation, but your in-person doctor is less exposed.

N.B. this is how I understand the things that my wife has said to me. She is actually a pharmacist who has to deal with these things, and I might have garbled something.

Re: ADHD drug treatment and risk of negative events and outcomes

#186

Post by hinkley »

pesus wrote: post #140
hinkley wrote: post #107

Earlier quoted context omitted.

I've heard it argued that ADHD diagnoses should come with a social worker. Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst. One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a dra…

I'm of course not recommending or condoning this, but with instant release it's definitely possible to also get a higher dosage than you actually need and cut the pills up to take the lower dosage you need, and stash the rest to build up a surplus. Or so I've heard.

The extended release means you only have to remember to take the medication once a day instead of twice.

What we need is for these pills to be compounded the way they do opioids: the wax granules are arranged to attempt to keep you from getting a burst dose by crushing the pills. The same process that makes crushing work makes splitting not work. So if you make split pills still time release, no problem.

But not for saving pills. Some people are exquisitely sensitive to these medications and you need 25mg per day but it only comes in multiples of 10 up to 50. So you’d like to split a 50 and take 1/2 pill per day. Also the 40mg often costs only 30-40% more than the 20.

Re: ADHD drug treatment and risk of negative events and outcomes

#187

Post by thelaxiankey »

alexrp wrote: post #156
jmogly wrote: post #118

I was diagnosed as a kid, I never really took the meds consistently. My perspective now is that adhd people are a minority tribe, very chill people living in an unchill world. I feel blessed that I have the ability to function and find my place in this world without taking the meds, not everyone with the “disease” is so lucky. Having adhd you feel alot like an alien most of the time, which can of course be alienating…

> The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive? Overwhelmingly the former in my case. I'll have projects that I desperately want to work on for weeks or months, but just can't bring myself to actually get started on without the extra push from Vyvanse. It would be nice if society could be just a bit more accommodating for people with ADHD, b…

the thing about being human is you internalize cultural values as your own.

if you lived in a society that valued, i dunno, tracking and hunting down giraffes in small groups, would you have the same struggles? what if just participating in society required ~20 hours of athletic activity a week? i'm not entirely convinced you would have this problem, based on the anthropology i've read.

the signal of a maladaptive culture is not 'i feel like the people around me have a moral failing'. It is 'i, and many others, feel like we've all got basically the same moral failing.'

personally, this has been a very helpful reframing. If I simply can't bring myself to do something, that means not that I am bad and my willpower is bad, it just means that something is materially wrong and I should consider addressing it by doing things that my body will let me do.

Re: ADHD drug treatment and risk of negative events and outcomes

#188

Post by jasonfarnon »

Nikolas0 wrote: post #168

My $0.02 as a response to several comments I read in this thread: I was diagnosed with ADHD in my 40s and got Concerta. My belief is that ADHD is not a disease, nor a disability (even though it acts like one very frequently) and in fact there is evidence that ADHD is an important part of our evolution as a species. The problem(s) mostly relies with the modern way of life and what is expected from the society at large…

"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."

I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

Re: ADHD drug treatment and risk of negative events and outcomes

#189

Post by jasonfarnon »

enneff wrote: post #176
homefree wrote: post #133

My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs) and ADHD is kind of a weakly differentiated diagnosis that could apply to most people. Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

The science doesn’t support your hypothesis btw.

Meaning what? All those college kids who took a friend's ritalin prescription to complete a term paper could have done just as well without it? I'm skeptical. Some of us wouldn't have even done the term paper without it, or would have mailed it in. I tend to think of it as little different than steroids. Maybe there's a bigger boost for some individuals than others, but the boost is probably across the board.

Re: ADHD drug treatment and risk of negative events and outcomes

#190

Post by b8 »

It took 3 months just to get get an initial appointment with my Psychologist and then two months later to get formally tested. Another month wait afterwards to meet with her and get treatment started (Adderall, Xanax etc.). I moved to Kentucky for college and the college doctors as well as many local psychiatrists wouldn't refill my Adderall and Xanax. It took me 3 months of fighting with the college health center to get them to find me a place that would refill and take over my mental health care. My Psychologist couldn't refill them out of state. It's annoying long to get care and to have to fight with doctors.
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