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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

#291

Post by wahern »

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...

That document is quite confusing, at least when skimming it. There's actually a bullet point on one page that says, "The current interruption to supply is NOT related to any DEA production quotas or restrictions on API."

That may be technically true, or perhaps it's just a false assertion included in the document dump. But AFAIU the issue is that the DEA tightly controls production and distribution of bulk amphetamines. There's just not a global quota, but per manufacturer quotas as well as requirements for allocation for each product. For example, the DEA sets a supply quota for 40mg pill production separate from a 50mg prescription. So if a particular manufacturers supply for 40mg pills is exhausted but they have tons for 50mg pills, too bad unless and until you go through an onerous process with the DEA to reallocate. It gets even worse across manufacturers. If manufacturer A has to shut down their production facility for some reason, manufacturers B and C can't easily pick up the slack. That's because reallocation of amphetamine supply to another manufacturer not only requires navigating a bureaucracy (that the DEA may very well slow walk given their present attitude), but it requires manufacturer A to voluntarily relinquish their quota, which they never do as there's zero benefit to them.

TL;DR: Technically global supply is more than adequate, but DEA rules, which effectively operate extraterritorially, create huge distribution problems. So the DEA can technically claim quotas aren't the problem, but that's at best highly misleading. If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.

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

#292

Post by hilux »

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.…

There are non-stimulant ADHD meds as well. Most of us don't get a chance to try all of them.

In fact, I was surprised to learn that Adderall is highly illegal in many countries, including Japan and South Korea(), both of which have a higher standard of healthcare, and a much longer life expectancy, than the US does. In other words, they're not anti-health.

() In theory, you can bring Adderall into South Korea with your American prescription. In practice, not really.

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

#293

Post by hilux »

aidenn0 wrote: post #260
0cf8612b2e1e wrote: post #153

Earlier quoted context omitted.

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.

You have to go into a doctor every month and get a new paper prescription for hormonal birth control? In the US? 20 years ago, my wife was able to do an electronic prescription, and it automatically refilled at the pharmacy every month. For stimulants, they can't do an electronic refill, so I literally had to go to my doctor, get a paper prescription, then drop it off at the pharmacy, then come back a few days later…

Definitely for Adderall, and possibly for birth control, the regulations vary greatly by state.

Of course, it wouldn't surprise me if hormonal birth control were to be Federally banned before this White House is done.

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

#294

Post by skissane »

wahern wrote: post #291
Maxious wrote: post #271

Earlier quoted context omitted.

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...

That document is quite confusing, at least when skimming it. There's actually a bullet point on one page that says, "The current interruption to supply is NOT related to any DEA production quotas or restrictions on API." That may be technically true, or perhaps it's just a false assertion included in the document dump. But AFAIU the issue is that the DEA tightly controls production and distribution of bulk amphetamin…

> There's just not a global quota,

There is no global quota. There are national quotas set by every country's government. US law nominates the DEA as the agency which does that for the US. Each country's government reports their national quotas to a UN agency (the INCB), but the UN agency has no power over them – at the very worst, they might criticise your quotas, but probably not even that; and more powerful countries (not just the US, even middle powers like Australia) can ignore what UN bureaucrats think with impunity – some poor developing country it may be a different story, especially if aid decisions are tied to getting a "good report card" from those bureaucracies.

And while for the DEA, setting these quotas is part of some grand moral/ideological crusade, for EU governments and Australia it is just technocratic paperwork – so of course those governments approach the issue much more reasonably than the DEA does.

> but DEA rules, which effectively operate extraterritorially, create huge distribution problems.

I don't see how they do. Lisdexamfetamine sold in Australia is manufactured by Takeda in Germany and Ireland. The DEA lacks jurisdiction over what a Japanese company does in EU and Australia. Although the drug was originally developed in the US, the Australian patent is currently owned by the Japanese parent company, not its American subsidiary, while the American subsidiary owns the "Vyvanse" trademark in Australia; anyway, DEA jurisdiction is based on manufacture in the US or US import/export, not country of development or IP ownership.

> If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.

In Australia's case they can't because lisdexamfetamine is still under patent, so other manufacturers are illegal – not because of the DEA, because Takeda will sue them. Takeda could license other manufacturers voluntarily, but why would they do that? That might be great for patients, but probably not so great for their shareholders.

I'm no fan of the DEA, but blaming the DEA for something that happens in Australia appeals to people emotionally even if it isn't true, whereas blaming patent law and the business decisions of a Japanese corporation is more truthful but less emotionally satisfying.

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

#295

Post by terminalshort »

justinator wrote: post #248
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.

Are we talking Adderall? I would be amazed if it still works at all on you. It seems research is showing that stimulants work for ADHD, until it doesn't. If it is Adderall, do you cycle on and off, or what's your protocol? (curious is all)

It's worked for me for 20 years

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

#296

Post by sneak »

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 regularly travel for 4-6 months at a time and I have several prescriptions that I must take daily for years/decades and they’re not even controlled substances. Getting >60 day supplies is like pulling teeth.

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

#297

Post by herbst »

toasted-subs wrote: post #206

The funny thing about this is sex actually does a good job at treating ADHD symptoms. Sad to see most doctors prescribing medication instead of helping kids get laid. Almost argue most adults are doing the opposite which makes me concerned for the population.

I find the effect very short lifed personally.

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

#298

Post by herbst »

totablebanjo wrote: post #109
groby_b wrote: post #85

Earlier quoted context omitted.

This doesn't even account for the perma-drama due to the artificial shortage generated by the DEA. Getting your prescription filled, if you manage to wrangle one, often requires hours of calling around which pharmacy can fill said prescription. And you get to do that every months. And you can't get a prescription earlier, you have to wait a full month. So, essentially: Right when you're forced off your medication tha…

The hoops I have to jump through for a prescription I’ve been on for multiple years is ridiculous. My insurance will wrongly think I’ve filled it at a CVS I sent the script to hoping they’d have it in stock and then I sometimes end up paying out of pocket because otherwise I am exhausted all day and have limited capacity to do tasks. The meds themselves have dramatically improved my life by being more capable of gett…

That's not what you want to hear I guess. But Adderall has a dirty crash, using pure Dextroamphetamine and not one of this mix pills makes the crash more bearable and less tiring

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

#299

Post by nickff »

astrange wrote: post #270
hnthrowaway847 wrote: post #226

Earlier quoted context omitted.

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.

It doesn't matter who funds a study if it's properly designed. You see this kind of dismissal on /r/science all the time and it's always just evidence that they're not qualified to actually read the study.

The only thing more popular (on those/these forums) than shallow dismissal is piling on (i.e. the recent Coldplay episode).

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

#300

Post by bawolff »

unmole wrote: post #285
bawolff wrote: post #269

Earlier quoted context omitted.

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

- Supply chains - Skilled workforce - Risk capital - Regulatory overhead

Other drugs are made outside the USA, what is so special about adderal (besides us regulations which other countries dont have to listen to)
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