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ADHD drug treatment and risk of negative events and outcomes

bmj.com

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

#231

Post by Spooky23 »

arcfour wrote: post #182
Spooky23 wrote: post #106

Earlier quoted context omitted.

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.

Insurance adds another bureaucratic hoops that negatively impacts patient care and outcomes.

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

#232

Post by mat_b »

hinkley wrote: post #184
baby_souffle wrote: post #144

Earlier quoted context omitted.

> 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.

You gotta start skipping a day sometimes or taking 1/2 on some days. Then you'll accumulate a reserve.

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

#233

Post by matheusmoreira »

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.

Stimulants will stimulate anyone with a nervous system. It's just that ADHD patients will respond disproportionately well to the treatment, thereby justifying the risks.

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

#234

Post by elcritch »

pessimizer wrote: post #200
elcritch wrote: post #179

Earlier quoted context omitted.

I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license. Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them. Then the DEA seems to consider stimulants as a moral failing. I’ve been o…

[flagged]

> (which has no physical diagnosis criteria, just a subjective checklist),

An ADHD diagnosis is not just subjective checklist. There's little regulation, but in order to get federal ADA accommodations in gradschool I had to get a diagnosis that took weeks. First I had a professional IQ exam which took 6 hours and highlighted that certain sub-scores were low indicative of ADHD, in particular working memory. Then there was testing with reflexes and attention regulation via computer testing. Finally there wad several counseling sessions reviewing childhood patterns and history, life and work impacts, etc.

Also you can scan ADHD brains with fMRI and see the differences.

> Why in the world would anybody be motivated to suppress the widespread usage of adderall for ADHD

Similar reasons as to why you're throwing shade at ADHD diagnosis criteria and hinting at that ADHD is fake. Maybe it's just ableism or puritanical views against the idea of stimulants.

Perhaps moral aspersions on a group of people whose symptoms look like they're just lazy. This is the most common in my experience.

> Who would be bribing them?

Some of the worse oppressors are those who do it because they believe they're doing it for your good. Perhaps beaurocrats enjoying the power in their fiefdom.

> Do you think that the DEA gets to make decisions about drug policy,

Well yes, especially before the Chevron doctrine was overturned recently by the Supreme Court [1]. Even Congress doesn't know what the DEA set their quotas for schedule 2 drugs at [2].

> or that they all belong to some secret anti-adderall church?

Heh, you'd be surprised [3].

1: https://www.scotusblog.com/2024/06/supreme-court-strikes-dow... 2: https://oversight.house.gov/wp-content/uploads/2024/05/Lette... 3: https://www.bunkhistory.org/resources/the-cult-of-j-edgar-ho...

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

#235

Post by Spooky23 »

mrexroad wrote: post #207
Spooky23 wrote: post #172

Earlier quoted context omitted.

That’s a good point on the nicotine. I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated…

Clinically ADHD and suspected APD here. I also have excellent hearing in both ears (20k+ hz), but I’m shit at understanding conversations in noisy environments… especially if my wife is speaking. Her voice is markedly harder for me to process than other people’s when there’s background noise. She used to assume I was being ADHD and not paying attention, etc, and get frustrated, but after years of me visibly focusing…

Yeah that’s remarkably similar to my experience. The only surprise is that my hearing was excellent — all of those punk shows in the 90s didn’t damage my hearing!

If it bugs you, a good audiologist or instrumentation specialist can measure the frequencies impacted and mitigate it with hearing aids. I tried it, and i would best describe it like transitioning from 1080p to 4k. The gotcha is the hearing aids are expensive and it is difficult to get a diagnosis that insurance will cover as it’s technically not a hearing loss.

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

#236

Post by skissane »

baby_souffle wrote: post #134
llbbdd wrote: post #121

Earlier quoted context omitted.

Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.

> Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that. There are a few providers out there. The DEA is cracking down on them (they call them "pill mills") and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years. The /r/ADHD sub has some good discussio…

> and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years.

Australia has been experiencing psychostimulant shortages in recent years, but they haven’t been due to the DEA (or Australian equivalent thereof-most of the DEA’s functions are state government responsibilities in Australia), they’ve been explained as due to manufacturing issues and growing demand - https://www1.racgp.org.au/newsgp/clinical/further-adhd-medic... - while I totally believe the US is facing additional issues due to its own regulatory regime, if Australia is having supply issues independent of that factor, why wouldn’t the US too?

Since controlled substances prescribing is a state issue in Australia, each state has its own policies - but I know my state (NSW) has been loosening regulation not tightening it - https://www1.racgp.org.au/newsgp/clinical/first-phase-of-gp-...

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

#237

Post by smohare »

pessimizer wrote: post #200
elcritch wrote: post #179

Earlier quoted context omitted.

I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license. Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them. Then the DEA seems to consider stimulants as a moral failing. I’ve been o…

[flagged]

[dead]

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

#238

Post by mrlongroots »

jakkos wrote: post #219
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.

> ADHD is kind of a weakly differentiated diagnosis that could apply to most people I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".

I have diagnosed ADHD and I agree largely with the person you are responding to.

The claim is not that ADHD is not a set of people with real psychiatric disorders, but it is a loose umbrella for what are actually disparate problems.

I recently learned that my symptoms, to a large extent, can be explained more accurately as POTS or something adjacent, and the meds I guided my psychiatrist towards were far more helpful than the stimulants I was being prescribed. This was a combination of me, reddit, and later LLMs arriving at me-specific diagnoses that go beyond clinical guideline regimes.

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

#239

Post by hombre_fatal »

1659447091 wrote: post #181
hombre_fatal wrote: post #137

Earlier quoted context omitted.

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 w…

Interesting. I got a 90-day bottle from a doc in my hometown until 2022. That's when I moved back to Texas but didn't want to drive all the way to my hometown anymore to see that doc.

Now I go to some "psychiatrist" pill mill where they made me take a BS $200 computer test to diagnose me with ADHD (CYA even though I've been taking this drug for 16 years) and they ask me the same goofy questions every televisit (probably more CYA).

Yeah, it was $1000-1200 for 90 pills of Vyvanse all that time. GoodRX only knocked it down $200 or so. And the website coupon only applies to 30-day.

Now with insurance, Vyvanse is $100 for 30 while generic is $10.

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

#240

Post by neuronexmachina »

hnthrowaway847 wrote: post #226
mandevil wrote: post #185

Earlier quoted context omitted.

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 t…

I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization. I was on various forms of prescribed amphetimines for years and developed paranoia. It took me a few years to somewhat recover. My family has PTSD about that period of my life. I can’t think or communicate well anymore. Fuck that industry.

> I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.

Funding info is at the bottom of the article, the project was primarily funded by the Swedish government.

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