ADHD drug treatment and risk of negative events and outcomes • Hacker News Board

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

#281

Post by spangry » Sat, Aug 16, 2025, 5:37 AM UTC

Spooky23 wrote: post #172

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.

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…

Pretty sure that's what I have too (and am diagnosed ADHD). I used to complain to my Mum that I couldn't hear what people were saying on the bus back home from school. She took me to get a hearing test and it turns out I have bat-like hearing. I'm just not able to seperate out speech from background noise - noisy restaurants and bars are a nightmare.

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

#282

Post by com2kid » Sat, Aug 16, 2025, 5:54 AM UTC

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…

Mail order pharmacies (though insurance companies) are more likely to fill a 90 day stimulant script in my experience, solely because they really want to send out 90 day supplies for everything for whatever reason.

I don't trust the post office enough to bother.

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

#283

Post by Ancapistani » Sat, Aug 16, 2025, 5:54 AM UTC

notfromhere wrote: post #68

Ancapistani wrote: post #62

Earlier quoted context omitted.

Obviously it's characterized as a disorder, but I really think that perspective should be challenged. Like autism, the diagnostic criteria are almost exclusively framed in how other people are impacted or inconvenienced by it. Very little attention is paid to the experience of the person actually living with it. I see it as a difference, but not necessarily a disorder. As someone with "severe" ADHD there are tons of…

Do you have ADHD? Because as someone that has it, it's definitely very much something that heavily impacts the individual with it, and not just society. It's hard to consistent do things, form habits, maintain attention. You have almost a lack of object permanence, a hard time remembering long-term memories, etc. There are so many problems it causes that aren't even occupational related but lead to negative outcomes…

Yes, I have ADHD. Severe enough that I’ve lost jobs over it.

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

#284

Post by ljf » Sat, Aug 16, 2025, 5:59 AM UTC

mandevil wrote: post #185

mithametacs wrote: post #101

Earlier quoted context omitted.

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 t…

I found this article about the steps the DEA are taking, really interesting https://www.catherinemccarthymd.com/med-shortage-news-1/the-...

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

#285

Post by unmole » Sat, Aug 16, 2025, 6:07 AM UTC

bawolff wrote: post #269

lysp wrote: post #263

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. The other thing on top of limiting its production, it's not just for the US, it's worldwide. Australia has a shortage of various types of ADHD medication due to this DEA production limit too. https://www.tga.gov.au/safety/shortages/information-about-ma... Also, the Austr…

Is there something stopping other countries from spinning up a factory?

- Supply chains

- Skilled workforce

- Risk capital

- Regulatory overhead

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

#286

Post by rollulus » Sat, Aug 16, 2025, 6:08 AM UTC

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…

You might enjoy reading “The ADHD advantage” by Anders Hansen. He describes the evolutionary explanation as well.

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

#287

Post by fragmede » Sat, Aug 16, 2025, 6:10 AM UTC

al_borland wrote: post #102

alfiedotwtf wrote: post #54

Earlier quoted context omitted.

Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.

How do you feel after those drives of a few hours? I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have. I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tom…

I bought a new-to-me car that supports Comma.ai. It's not full self driving, but it handles the boring parts sitting on the freeway for me. it's the best purchase I've made in recent memory because holy shit sitting there on the freeway forever is the worst.

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

#288

Post by skissane » Sat, Aug 16, 2025, 6:16 AM UTC

Maxious wrote: post #271

skissane wrote: post #236

Earlier quoted context omitted.

> 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 growin…

The shortages are due to the DEA, you can read the documents on the TGA FOI website what "manufacturing issues" really means https://www.reddit.com/r/ausadhd/comments/1mhdmgs/foi_250162...

Since last year, lisdexamfetamine sold in Australia has been manufactured in Germany (API) and Ireland (packaging). The DEA has zero jurisdiction over a drug manufactured in Germany/Ireland and then exported from there to Australia–US quotas do not apply, the relevant quotas are the German/Irish/Australian quotas set by their respective governments (which governments appear to take a much more flexible and responsive approach to doing so than the DEA does). Takeda said that GMP issues in the Irish plant were causing supply problems – and I don't see any reason to disbelieve them; GMP is a TGA/FDA/EMA issue not something the DEA has any authority over.

The biggest cause of Australia's lisdexamfetamine supply issues isn't the DEA, it is patent law – the US patent expired in 2023, the Australian patent doesn't expire until 2028, which gives Takeda a continuing near-monopoly on lisdexamfetamine in the Australian market – so if Takeda is having problems meeting the growing demand, it is legally very difficult for other firms to step in. The TGA did for a period allow emergency parallel import – but I don't know if that included generics, and my own experience was it wasn't clear how to even access it – my impression is that for most patients it was more of a theoretical allowance than something practically helpful to them.

I think the biggest thing the DEA is doing here is damaging the US' own pharmaceutical manufacturing industry by pushing controlled substances production out of the US and into friendlier countries in Europe and Asia. The DEA can't cause any lasting issues with controlled substances availability in Australia because their jurisdiction is legally limited to the United States. Even if we suppose the DEA may have temporarily contributed to supply issues in Australia – surely equal blame lies at Takeda for being too slow at moving manufacturing out of the US.

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

#289

Post by pygy_ » Sat, Aug 16, 2025, 6:17 AM UTC

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.

I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking.

I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).

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

#290

Post by xlii » Sat, Aug 16, 2025, 6:27 AM UTC

hinkley wrote: post #186

pesus wrote: post #140

Earlier quoted context omitted.

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…

One thing to keep in mind that methylphenidate is contextual and metabolic related.

Hard focus work could make it work shorter, but also some have metabolism so quick that they burn through medication. That's controlled by doctors so no worries, but I know people who take IR forms every 2 hours, and for those XR forms don't work at all (as it's like 2 complete cycles with all side effects).