The Origin of Adderal shortages
August 26, 2024 9:16 AM Subscribe
This Is Why You Can't Get ADHD Treatment Musician / Investigative Documentarian Benn Jordan breaks down the core reasons for the USA's ADHD medication shortage, the hassle of trying to solve it yourself, why it's so profitable for so many drug companies, the scams that have popped up in response, and the dangers of seeking treatment via the dark web.
Back when I was deemed "inconclusive" for this topic, I was told that they wouldn't diagnose me (a) since I had depression going on and (b) they only diagnose you if they think ADHD meds would help. I was told my insurance wasn't going to ever consider further re-evaluation again. I've been debating now that I've had to change insurance if I want to try to fight this diagnosis battle again (at this point I'm not having the bad issues that caused me to look for a diagnosis, since I'm out of the hell job), but frankly it seems not worth it to try since the meds are just not available any more. I'm also not constantly making mistakes from stress any more, even if I still have what I consider to be the positive traits of it like needing fidget objects.
posted by jenfullmoon at 9:36 AM on August 26 [6 favorites]
posted by jenfullmoon at 9:36 AM on August 26 [6 favorites]
Ugh. My partner went to work today without his Adderall because of this. It's a major problem for us, because it's very hard for him to function professionally without it.
He has a stash of "booster" Adderall pills that he's supposed to take in the afternoon, but skips sometimes because when there's a shortage he can use those to survive...
It's really infuriating how hard it is to get the medication that allows him to function.
posted by constraint at 9:36 AM on August 26 [15 favorites]
He has a stash of "booster" Adderall pills that he's supposed to take in the afternoon, but skips sometimes because when there's a shortage he can use those to survive...
It's really infuriating how hard it is to get the medication that allows him to function.
posted by constraint at 9:36 AM on August 26 [15 favorites]
I'd appreciate if someone would post a summary of the issue. Thanks.
posted by seanmpuckett at 10:02 AM on August 26 [8 favorites]
posted by seanmpuckett at 10:02 AM on August 26 [8 favorites]
Addies from the dark web (or anywhere that's not a licensed pharmacy, really) are going to be caffeine, amphetamine sulfate, methamphetamine, various substituted cathinones, or some hodgepodge of those. Ask me how I (allegedly) know.
There is a lot of Discourse Online grumbling about how Adderall is basically "kiddie meth," and that is prompting a lot of college students to seek actual meth as a substitute for their unavailable prescriptions. Street meth these days is usually adulterated as well. It's sickening.
posted by infinitewindow at 10:08 AM on August 26 [2 favorites]
There is a lot of Discourse Online grumbling about how Adderall is basically "kiddie meth," and that is prompting a lot of college students to seek actual meth as a substitute for their unavailable prescriptions. Street meth these days is usually adulterated as well. It's sickening.
posted by infinitewindow at 10:08 AM on August 26 [2 favorites]
Dealing with this now, they're winning because I'm about to just not even bother. I've lived almost 50 years with this shit, why should I try to be better now. It's infuriating. I needed a referral to check on my "depression and anxiety" (which I do have, and have been treated for for 20+ years and Effexor (the drug I'm on, yay, lucky fuckin me, THE Serotonin Withdrawal drug, apparently))... And because I've "survived' (not thrived, and have SUCH issues with motiviation/initiation and now, the benefit of "hyperfocus" is gone in older age, this ain't cutting it). They gave me "clonidine" for "stress/anxiety" (due to burnout stress at work which I got fired from like 6 months later in a mass layoff) Well guess what that's not the issue, I don't need a slower brain I already get that with effexor I need a brain to "clear" things, to help with executive dysfunction and motivation. I'm more inattentive than hyperactive, and it's just worse now, and memory sucks, and god fuck these people making life so hard. DEA saying "oh there's not an increase it's just people being addicts" fuck you some of us were undiagnosed and had jokes made for years. When I first tested for stuff in 2004-ish (or earlier, it's been so long at this point) - ADD was one thing and I was on the threshold, the idea was treating the other stuff first with effexor. But goddamn I think I would have been in a better place if I could have at least TRIED to see if it works.
I have when I was younger taken large quantities of caffeine (like dangerously - 12 no-doze) and also had "mini-thins" (back when ephedrine was legal), and also ritalin illicitly diverted from my coworker which was shady, I admit. Caffeine just made me sick and want to sleep it off; large amount of minithins to "buzz" had me initially awake but then I just wanted to sleep. LIkewise, ritalin just made me want to sleep. It makes me think -maybe I DO have ADHD as I know this can affect ADD people like that. But yeah, go ahead, I"m just a fucking seeker.
Also apparently you have to be "drug free" and how dare someone try to self-medicate with weed their entire lives since that's easier to get than legal speed. Ironic, huh? but yeah, you MUST be a drugee cuz all drugs are the same apparently and all people who use any drug are at risk of any other substance abuse.
The way we handle drugs and think about them, even from the "professionals" in our country is so fucking puritanical and evil. And it doesn't even actually solve the problems they profess to solve, just make people suffer more, in prisons, in health, etc... Fuck the DEA.
posted by symbioid at 10:19 AM on August 26 [24 favorites]
I have when I was younger taken large quantities of caffeine (like dangerously - 12 no-doze) and also had "mini-thins" (back when ephedrine was legal), and also ritalin illicitly diverted from my coworker which was shady, I admit. Caffeine just made me sick and want to sleep it off; large amount of minithins to "buzz" had me initially awake but then I just wanted to sleep. LIkewise, ritalin just made me want to sleep. It makes me think -maybe I DO have ADHD as I know this can affect ADD people like that. But yeah, go ahead, I"m just a fucking seeker.
Also apparently you have to be "drug free" and how dare someone try to self-medicate with weed their entire lives since that's easier to get than legal speed. Ironic, huh? but yeah, you MUST be a drugee cuz all drugs are the same apparently and all people who use any drug are at risk of any other substance abuse.
The way we handle drugs and think about them, even from the "professionals" in our country is so fucking puritanical and evil. And it doesn't even actually solve the problems they profess to solve, just make people suffer more, in prisons, in health, etc... Fuck the DEA.
posted by symbioid at 10:19 AM on August 26 [24 favorites]
on preview, what jenfullmoon said, 100%
posted by symbioid at 10:20 AM on August 26 [2 favorites]
posted by symbioid at 10:20 AM on August 26 [2 favorites]
Street meth these days is usually adulterated as well
Last I read street meth was probably actually purer than it’s been in a long time but that’s not up to pharmaceutical standards, obviously.
posted by atoxyl at 10:26 AM on August 26 [3 favorites]
Last I read street meth was probably actually purer than it’s been in a long time but that’s not up to pharmaceutical standards, obviously.
posted by atoxyl at 10:26 AM on August 26 [3 favorites]
I'd appreciate if someone would post a summary of the issue. Thanks.
I have no idea who Benn Jones is, and I'm not going to turn to a musician for guidance on something as complex as regulated drug manufacturing in the United States.
That said, the causes of the current shortage are multiple, including: Adderall prescriptions are up for a variety of reasons, including the significant increase in the availability of telehealth since 2020. Manufacturing is regulated by two government agencies - FDA and DEA - who don't always collaborate smoothly. DEA sets the production numbers annually, informed by prescription numbers (and thus, will always have production lagging demand). Companies can request off-cycle changes to production levels, but they report that DEA tends not to be responsive to their requests. There have also been manufacturing issues in recent years in part because of our reliance on foreign components for US drug manufacturing. Congress could take any number of steps to fix many of these issues, but have not done so.
posted by NotMyselfRightNow at 10:33 AM on August 26 [12 favorites]
I have no idea who Benn Jones is, and I'm not going to turn to a musician for guidance on something as complex as regulated drug manufacturing in the United States.
That said, the causes of the current shortage are multiple, including: Adderall prescriptions are up for a variety of reasons, including the significant increase in the availability of telehealth since 2020. Manufacturing is regulated by two government agencies - FDA and DEA - who don't always collaborate smoothly. DEA sets the production numbers annually, informed by prescription numbers (and thus, will always have production lagging demand). Companies can request off-cycle changes to production levels, but they report that DEA tends not to be responsive to their requests. There have also been manufacturing issues in recent years in part because of our reliance on foreign components for US drug manufacturing. Congress could take any number of steps to fix many of these issues, but have not done so.
posted by NotMyselfRightNow at 10:33 AM on August 26 [12 favorites]
His name is Benn Jordan, but you probably still haven't heard of him.
posted by I-Write-Essays at 10:47 AM on August 26 [1 favorite]
posted by I-Write-Essays at 10:47 AM on August 26 [1 favorite]
Thank you for the correction - Benn Jordan, not Benn Jones.
posted by NotMyselfRightNow at 10:49 AM on August 26
posted by NotMyselfRightNow at 10:49 AM on August 26
I think the salient bit of criticism is that in response to more prescriptions, the DEA *lowered* the quota in 2022. I don't actually have any reference to tell if that's true or not, but it's not the first time I've heard it.
posted by atbash at 10:57 AM on August 26 [1 favorite]
posted by atbash at 10:57 AM on August 26 [1 favorite]
I would say - watch the video, it's far more informative and interesting than I expected (and it's not just the DEA) he also mentions sytemic issues (and manufacturers not being required to state WHY they are below the limits, the DEA says a billion more pills (IIRC from watching) could be produced. But the companies aren't. So it's not even the DEA in this case. Thanks Benn for updating my understanding.
Benn is a good dude, smart and not an idiot. He's smart and does a LOT of research. Some of this is personal experience, but he does dig into issues, please watch without the dismissive "I don't know why I should listen to just an idiot rando musician" (I could say the same about random mefi users (including myself, FYI)).
posted by symbioid at 10:59 AM on August 26 [8 favorites]
Benn is a good dude, smart and not an idiot. He's smart and does a LOT of research. Some of this is personal experience, but he does dig into issues, please watch without the dismissive "I don't know why I should listen to just an idiot rando musician" (I could say the same about random mefi users (including myself, FYI)).
posted by symbioid at 10:59 AM on August 26 [8 favorites]
I would watch the video except I can't focus well enough to absorb information that way
posted by The otter lady at 11:20 AM on August 26 [17 favorites]
posted by The otter lady at 11:20 AM on August 26 [17 favorites]
An extra annoying bit is that a year or two ago, the FDA banned 90 day refills, you have to do 30 days now. And since you can't get them through the mail, you have to go to the pharmacy in person every 30 days, which is obnoxious at best and if you are carless (as I am effectively right now) expensive and difficult. The official reason was that patients were building up stashes by not taking meds on the weekends or whatever and so they wanted to make it more difficult.
And I was "of course every ADHD patient builds up a stash if they can, because you fuckers have set it up so that you have no idea if you'll be able to get the next prescription filled on time!"
posted by tavella at 11:36 AM on August 26 [40 favorites]
And I was "of course every ADHD patient builds up a stash if they can, because you fuckers have set it up so that you have no idea if you'll be able to get the next prescription filled on time!"
posted by tavella at 11:36 AM on August 26 [40 favorites]
DEA sets the production numbers annually, informed by prescription numbers (and thus, will always have production lagging demand). Companies can request off-cycle changes to production levels, but they report that DEA tends not to be responsive to their requests.
Companies aren't producing to their authorized levels, though.
posted by praemunire at 11:38 AM on August 26 [2 favorites]
Companies aren't producing to their authorized levels, though.
posted by praemunire at 11:38 AM on August 26 [2 favorites]
Companies aren't producing to their authorized levels, though.
As an industry they weren't producing to full quotas. But quotas on an individual company basis are a different story. They don't follow market share changes throughout the year at all, being set in March and April. So if a company scores a big contract with a pharmacy chain they might run out of quota and be stuck begging the DEA to up it and at that point who knows. Combined with an across the board quota cut in 2023, you end up in an even worse situation because now your fat that would absorb that extra demand is gone. And if you can't supply to the pharmacy, who have negotiated a huge exclusive contract for a huge discount, and those pharmacies don't have alternatives ready to go, the patients at that pharmacy are left up shit creek without a paddle and a DEA head going "well there's quota abound..."
posted by Your Childhood Pet Rock at 11:57 AM on August 26 [2 favorites]
As an industry they weren't producing to full quotas. But quotas on an individual company basis are a different story. They don't follow market share changes throughout the year at all, being set in March and April. So if a company scores a big contract with a pharmacy chain they might run out of quota and be stuck begging the DEA to up it and at that point who knows. Combined with an across the board quota cut in 2023, you end up in an even worse situation because now your fat that would absorb that extra demand is gone. And if you can't supply to the pharmacy, who have negotiated a huge exclusive contract for a huge discount, and those pharmacies don't have alternatives ready to go, the patients at that pharmacy are left up shit creek without a paddle and a DEA head going "well there's quota abound..."
posted by Your Childhood Pet Rock at 11:57 AM on August 26 [2 favorites]
Corporate healthcare == death panels.
posted by Abehammerb Lincoln at 12:15 PM on August 26 [11 favorites]
posted by Abehammerb Lincoln at 12:15 PM on August 26 [11 favorites]
Right, I can't watch talk-y videos either. I clicked on the auto-generated transcript, and have skimmed far enough (to 4:25) for Jordan to say,
Treating ADHD patients with medication linked to lower risk of death overall, study finds (CNN, March 12, 2024)
A study published in JAMA in March 2024 found that people with ADHD who took medication had a 19% lower risk of death over two years than those who did not. The study included 148,578 people diagnosed with ADHD in Sweden, both adults and children, and found a significant difference in deaths due to unnatural causes, such as accidental injuries, suicide, and accidental poisonings. The researchers found that people who took medication from the start of their diagnoses had more than a 20% lower risk of death due to any cause. - summary from Google's irrepressible AI.
Now Jordan's going into those unnatural causes of death (car accidents, for example) and referencing additional studies on this subject. JAMA's dry summary of the study, which, again, included adults and children: Among individuals diagnosed with ADHD, medication initiation was significantly associated with lower mortality, in particular for unnatural causes.
Please don't get sidetracked by job productivity stats, corporate greed, or drug abuse potentialities — not if the shortage much more about its effect on preventative fatalities, what the suppurating fuck.
posted by Iris Gambol at 12:35 PM on August 26 [28 favorites]
Let's start with the most direct and horrifying statistic that you're going to hear in this video. In a study published earlier this year, it was found that people receiving treatment for ADHD in the form of medication has a 19% lower risk of death than those who are not being treated, and this is a really legit study tracking hundreds of thousands people in each group over a period of two years —"ADHD Pharmacotherapy and Mortality in Individuals With ADHD" (JAMA, March 12, 2024) is the study.
Treating ADHD patients with medication linked to lower risk of death overall, study finds (CNN, March 12, 2024)
A study published in JAMA in March 2024 found that people with ADHD who took medication had a 19% lower risk of death over two years than those who did not. The study included 148,578 people diagnosed with ADHD in Sweden, both adults and children, and found a significant difference in deaths due to unnatural causes, such as accidental injuries, suicide, and accidental poisonings. The researchers found that people who took medication from the start of their diagnoses had more than a 20% lower risk of death due to any cause. - summary from Google's irrepressible AI.
Now Jordan's going into those unnatural causes of death (car accidents, for example) and referencing additional studies on this subject. JAMA's dry summary of the study, which, again, included adults and children: Among individuals diagnosed with ADHD, medication initiation was significantly associated with lower mortality, in particular for unnatural causes.
Please don't get sidetracked by job productivity stats, corporate greed, or drug abuse potentialities — not if the shortage much more about its effect on preventative fatalities, what the suppurating fuck.
posted by Iris Gambol at 12:35 PM on August 26 [28 favorites]
An extra annoying bit is that a year or two ago, the FDA banned 90 day refills, you have to do 30 days now. And since you can't get them through the mail, you have to go to the pharmacy in person every 30 days, which is obnoxious at best and if you are carless (as I am effectively right now) expensive and difficult. The official reason was that patients were building up stashes by not taking meds on the weekends or whatever and so they wanted to make it more difficult.
? This isn't true; I get 90 day refills through the mail, unless it's just some medications and not others (I am on a stimulant, so that's not the differentiator(.
posted by ch1x0r at 12:53 PM on August 26
? This isn't true; I get 90 day refills through the mail, unless it's just some medications and not others (I am on a stimulant, so that's not the differentiator(.
posted by ch1x0r at 12:53 PM on August 26
It is some medications and not others.
posted by corb at 12:56 PM on August 26 [4 favorites]
posted by corb at 12:56 PM on August 26 [4 favorites]
Are you sure it's not a state law vs the FDA? Some states allow 90 days (mine does), others do not.
posted by ch1x0r at 1:00 PM on August 26 [1 favorite]
posted by ch1x0r at 1:00 PM on August 26 [1 favorite]
are we sure it's not state law, FDA regs, and insurance coverage, in a malodorous stew
posted by Iris Gambol at 1:16 PM on August 26 [6 favorites]
posted by Iris Gambol at 1:16 PM on August 26 [6 favorites]
Huh, my impression was that none of the stimulants can be via mail. What ADHD medication do you use, ch1xor? I might seriously think about asking my doctor if I can switch, at least temporarily, even though ritalin has worked well for me for 14 years.
posted by tavella at 1:29 PM on August 26
posted by tavella at 1:29 PM on August 26
Perhaps the title of Jordan's video seems a little misleading but its contents portray a snapshot of America's problematic healthcare system and how it fails the very people it is intending to serve. The root of the problem is in this game of telephone between several agencies which, in the process of attempting to create guidelines, creates more obstructions for patients in need. Jordan, as someone who has ADHD, effectively communicates how difficult it is to negotiate systems which refuse to understand the individual.
If you think that this isn't a pressing issue, it is likely that you know someone (partner, friend, family etc) who is also struggling with this issue yet doesn't have ADHD. The problem isn't just controlled substances but rather that the people who are denied treatment are forced to withdraw and there isn't any guarantee that the help they were promised from doctors will come at a reasonable pace or a reasonable timeline. Consumers absorb the loss not just financially but with their jobs, their relationships and their livelihoods. This is a massive failure of American governance and its reprecussions are already being felt locally and globally.
If you know someone affected, do everything you can to ensure their needs are tended to safely because, yeah, as someone who has had to withdraw from psychiatric meds forcibly, I personally know the risks can lead to lost wages, lost careers or worse yet, suicides.
posted by kayalovesme at 1:48 PM on August 26 [7 favorites]
If you think that this isn't a pressing issue, it is likely that you know someone (partner, friend, family etc) who is also struggling with this issue yet doesn't have ADHD. The problem isn't just controlled substances but rather that the people who are denied treatment are forced to withdraw and there isn't any guarantee that the help they were promised from doctors will come at a reasonable pace or a reasonable timeline. Consumers absorb the loss not just financially but with their jobs, their relationships and their livelihoods. This is a massive failure of American governance and its reprecussions are already being felt locally and globally.
If you know someone affected, do everything you can to ensure their needs are tended to safely because, yeah, as someone who has had to withdraw from psychiatric meds forcibly, I personally know the risks can lead to lost wages, lost careers or worse yet, suicides.
posted by kayalovesme at 1:48 PM on August 26 [7 favorites]
My kid is entirely reliant on a different stimulant medication for his AuDHD. Because adderall is experiencing shortages, other similar medications are experiencing shortages as people switch to any available medication.
We had been lucky to be able to get my kid what he needs without too much issue (combining smaller doses to get to his prescribed amount, cutting pills, opening capsules and dividing their contents) until this month when the mail order place and local pharmacies were all out of it.
I let other parents of kids at his special needs school know about our issue; let my boss know that my life might blow up as we tried to transition my kid to a new med (I have intermittent FMLA already set up but I try to be courteous to my workplace as we are already short two people in a crew of 12).
Then another parent in the parents text group just started calling pharmacies and found us another 30 days of his medication. And I almost cried in relief.
Because it would have been really, really bad.
posted by sciencegeek at 2:06 PM on August 26 [15 favorites]
We had been lucky to be able to get my kid what he needs without too much issue (combining smaller doses to get to his prescribed amount, cutting pills, opening capsules and dividing their contents) until this month when the mail order place and local pharmacies were all out of it.
I let other parents of kids at his special needs school know about our issue; let my boss know that my life might blow up as we tried to transition my kid to a new med (I have intermittent FMLA already set up but I try to be courteous to my workplace as we are already short two people in a crew of 12).
Then another parent in the parents text group just started calling pharmacies and found us another 30 days of his medication. And I almost cried in relief.
Because it would have been really, really bad.
posted by sciencegeek at 2:06 PM on August 26 [15 favorites]
are we sure it's not state law, FDA regs, and insurance coverage, in a malodorous stew
The DEA is the agency that regulates controlled drugs -- anything on Schedules II through V (Schedule I is illegal drugs). The rules are stricter for any controlled drugs but especially for Schedule II drugs, which all the ADHD stimulants like Adderall fall into.
Notably, Schedule II drugs can't be refilled, the doctor must write a new prescription every time, and the maximum allowed is a 30-day supply (to deter diversion, I assume). So yeah, these are federal-level rules. I assume not allowing mail order is a DEA rule too.
(The rules have actually been relaxed a bit since I was a pharmacy tech a decade ago: they used to require a paper prescription, but electronic prescriptions are allowed now.)
posted by neckro23 at 2:51 PM on August 26 [2 favorites]
The DEA is the agency that regulates controlled drugs -- anything on Schedules II through V (Schedule I is illegal drugs). The rules are stricter for any controlled drugs but especially for Schedule II drugs, which all the ADHD stimulants like Adderall fall into.
Notably, Schedule II drugs can't be refilled, the doctor must write a new prescription every time, and the maximum allowed is a 30-day supply (to deter diversion, I assume). So yeah, these are federal-level rules. I assume not allowing mail order is a DEA rule too.
(The rules have actually been relaxed a bit since I was a pharmacy tech a decade ago: they used to require a paper prescription, but electronic prescriptions are allowed now.)
posted by neckro23 at 2:51 PM on August 26 [2 favorites]
I dug up a copy of the study mentioned up thread: ADHD Pharmacotherapy and Mortality in Individuals With ADHD.
Gina Pera's website, called ADHD Rollercoaster is a great resource focused on Adult ADHD and their relationships. And one label for Pera might be "idiot rando journalist" or someone who has been in the trenches for decades:
Pera argues the current supply issues are the result of:
Gina Pera's website, called ADHD Rollercoaster is a great resource focused on Adult ADHD and their relationships. And one label for Pera might be "idiot rando journalist" or someone who has been in the trenches for decades:
- 2015: 14 Q&A overview of "Generics" versions of Concerta’s which lays out what an 'Authorized' generic is, and how other generics are not the same as brand. Generics are considered 'bioequivalence” if it's pharmacokinetic curve, or concentration of a drug in blood plasma over time, falls within 20% of the brand. Yes really.
- 2019: 9 part guide for Specifying Authorized Generic Concerta. Note: this is no longer an option in 2024 as it turns out the facility that was making it is busy with more profitable drugs! Pera covers the importance of the NDC Number and tips on dealing with pharmacy benefits managers. And Trumps FDA Chief Robert Gottlieb gets some attention for his role in making this mess.
- 2022: Janssen Quietly Ends Concerta Authorized-Generic. It's worth noting that Pera isn't against generics, only that the authorized generic Concerta "is a very popular choice that millions have relied upon for years—and they are losing it without a worthy replacement." Worthy in this case means that Concerta, and it's authorized generic both used a complex-delivery system, and none of the "generics" have that system.
Pera argues the current supply issues are the result of:
- A surge in diagnoses during COVID
- Issues at generic manufacturer Teva
- Prescribers relying on only a few medications
- “Big Generic” disrupting the ADHD medication landscape
- Pharmacy Benefit Managers manipulating access and costs
I was motivated to seek an ADHD diagnosis in large part because I noticed that when I had a cold and took Sudafed (the real stuff) I could just decide I was going to work on a thing, and do it, in contrast with every other day of my fsking life. I'll let everyone do with that information what they will.
posted by BrashTech at 3:39 PM on August 26 [3 favorites]
posted by BrashTech at 3:39 PM on August 26 [3 favorites]
As someone who may be put on an ADD med soon, this is not what I want to hear.
Ugh
posted by Windopaene at 3:43 PM on August 26 [1 favorite]
Ugh
posted by Windopaene at 3:43 PM on August 26 [1 favorite]
ADHD Medications Approved by the US Food and Drug Administration + infographic - CHADD.org article w/infographic, CHADD.org infographic .pdf
Nonstimulant medications for the treatment of ADHD, overview (second half of the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) [an ADHD education, advocacy, & support org] page "Medication Management for Adults"); if any could be an option for any of you, please consult with your health-care provider: With the exception of atomoxetine (Strattera), which will be discussed below, non-stimulant medications have generally been considered second-line medications. They have been used in people who have an incomplete response or no response to stimulants, cannot tolerate stimulants or have certain co-existing psychiatric conditions.
Antidepressants: Antidepressants that have a direct effect of increasing the neurotransmitter norepinephrine (but not serotonin as in the selective serotonin reuptake inhibitors [SSRIs] like fluoxetine) appear to have a positive effect on the core symptoms of ADHD. None of the antidepressants has been approved by the FDA for the treatment of ADHD in children, adolescents or adults; such treatment is considered off-label.
Antihypertensive agents: Clonidine (Catapres; Kapvay) and guanfacine (Tenex; Intuniv) are alpha-2 and alpha-2a noradrenergic agents, respectively, that may indirectly affect dopamine by first affecting norepinephrine [...] sedation and blood pressure lowering effects as well as potential hypertensive rebound are issues of concern. Long-acting preparations of clonidine Kapvay and guanfacine have been approved for ADHD in children and may also be helpful in adults.
Wake-promoting agent: Modafinil (Provigil) is approved by the FDA for the treatment of narcolepsy. Its main effect appears to be indirect activation of the frontal cortex rather than direct involvement in central dopamine and norepinephrine pathways. In a two-week, controlled study of modafinil, 48% of adults with ADHD responded favorably to the medication [...] modafinil’s utility may be limited to adults with ADHD who do not respond to first line medications. A variation of modafinil, armodafanil (Nuvigil) has become available in the United States.
Atomoxetine (Strattera) is approved by the FDA for the treatment of ADHD in children, adolescents and adults. It is a potent selective norepinephrine reuptake inhibitor. It is the first nonstimulant medication to be approved by the FDA for the treatment of ADHD and the first medication of any kind specifically approved for the treatment of ADHD in adults. It lacks the abuse potential of stimulants, and since it is not a controlled Schedule II drug, atomoxetine can be prescribed by telephone and with refills. (More info at that medication page.)
posted by Iris Gambol at 3:45 PM on August 26 [5 favorites]
Nonstimulant medications for the treatment of ADHD, overview (second half of the Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) [an ADHD education, advocacy, & support org] page "Medication Management for Adults"); if any could be an option for any of you, please consult with your health-care provider: With the exception of atomoxetine (Strattera), which will be discussed below, non-stimulant medications have generally been considered second-line medications. They have been used in people who have an incomplete response or no response to stimulants, cannot tolerate stimulants or have certain co-existing psychiatric conditions.
Antidepressants: Antidepressants that have a direct effect of increasing the neurotransmitter norepinephrine (but not serotonin as in the selective serotonin reuptake inhibitors [SSRIs] like fluoxetine) appear to have a positive effect on the core symptoms of ADHD. None of the antidepressants has been approved by the FDA for the treatment of ADHD in children, adolescents or adults; such treatment is considered off-label.
Antihypertensive agents: Clonidine (Catapres; Kapvay) and guanfacine (Tenex; Intuniv) are alpha-2 and alpha-2a noradrenergic agents, respectively, that may indirectly affect dopamine by first affecting norepinephrine [...] sedation and blood pressure lowering effects as well as potential hypertensive rebound are issues of concern. Long-acting preparations of clonidine Kapvay and guanfacine have been approved for ADHD in children and may also be helpful in adults.
Wake-promoting agent: Modafinil (Provigil) is approved by the FDA for the treatment of narcolepsy. Its main effect appears to be indirect activation of the frontal cortex rather than direct involvement in central dopamine and norepinephrine pathways. In a two-week, controlled study of modafinil, 48% of adults with ADHD responded favorably to the medication [...] modafinil’s utility may be limited to adults with ADHD who do not respond to first line medications. A variation of modafinil, armodafanil (Nuvigil) has become available in the United States.
Atomoxetine (Strattera) is approved by the FDA for the treatment of ADHD in children, adolescents and adults. It is a potent selective norepinephrine reuptake inhibitor. It is the first nonstimulant medication to be approved by the FDA for the treatment of ADHD and the first medication of any kind specifically approved for the treatment of ADHD in adults. It lacks the abuse potential of stimulants, and since it is not a controlled Schedule II drug, atomoxetine can be prescribed by telephone and with refills. (More info at that medication page.)
posted by Iris Gambol at 3:45 PM on August 26 [5 favorites]
We had our kid forego his meds most of the summer so that we'd have a buffer when school started again. It was rough last year, when he ran out of meds during a challenging stretch in math.
posted by DirtyOldTown at 4:20 PM on August 26 [1 favorite]
posted by DirtyOldTown at 4:20 PM on August 26 [1 favorite]
Maybe things have finally changed, but when I was taking ADHD meds stuff like Adderal and Ritalin was on a regular prescription slip, but the Dexedrine I took was on a DEA carbon triplicate with a serial number.
I had a terrible reaction to Strattera.
posted by snuffleupagus at 5:20 PM on August 26 [1 favorite]
I had a terrible reaction to Strattera.
posted by snuffleupagus at 5:20 PM on August 26 [1 favorite]
If you take a ritalin variation, look into Jornay. I sound like a salesperson for them at times but the basic premise of it is that you can take it the night before and it kicks in as you are waking up. It's marketed at kids who have tough mornings but I think waking up to the effects of the stimulants rather than potentially waking up having bad symptoms and having to remember to take something is probably an advantage for anyone with ADHD. I probably don't need to say anything else but I will add I've seen zero delays with it this year
posted by feloniousmonk at 5:31 PM on August 26 [2 favorites]
posted by feloniousmonk at 5:31 PM on August 26 [2 favorites]
In case it helps anyone, I have found the Canadian ADHD practice guidelines very helpful in containing extremely detailed information on medication options. Yet it's very forceful on the opinion that long-acting stimulants are the first line treatment. It's egregious that there is such a shortage in the US.
posted by lookoutbelow at 5:49 PM on August 26 [1 favorite]
posted by lookoutbelow at 5:49 PM on August 26 [1 favorite]
Huh, my impression was that none of the stimulants can be via mail. What ADHD medication do you use, ch1xor? I might seriously think about asking my doctor if I can switch, at least temporarily, even though ritalin has worked well for me for 14 years.
Ritalin, and concerta. I have been getting both of these 90 days through the mail for.... I dunno, 7-8 years, at least? I realize this depends on a) state and b) insurance company and probably c) doctor. But in my state (new york), with my insurance (which uses caremark for rx), I am able to get this and have been for years (and I was actually on OptimRX in this period of time also getting the 90 days). As an aside, the DEA allowed 90 day fills of Schedule II drugs in 2007, so this is now coming on 17 years, not "new". It drives me slightly bonkers that every single discussion of this on mefi devolves into "it's not possible to get 90 day fills". I can't get refills, and I'm sure it depends on state/doctor/insurance, but notably, this isn't the feds.
posted by ch1x0r at 5:52 PM on August 26 [3 favorites]
Ritalin, and concerta. I have been getting both of these 90 days through the mail for.... I dunno, 7-8 years, at least? I realize this depends on a) state and b) insurance company and probably c) doctor. But in my state (new york), with my insurance (which uses caremark for rx), I am able to get this and have been for years (and I was actually on OptimRX in this period of time also getting the 90 days). As an aside, the DEA allowed 90 day fills of Schedule II drugs in 2007, so this is now coming on 17 years, not "new". It drives me slightly bonkers that every single discussion of this on mefi devolves into "it's not possible to get 90 day fills". I can't get refills, and I'm sure it depends on state/doctor/insurance, but notably, this isn't the feds.
posted by ch1x0r at 5:52 PM on August 26 [3 favorites]
Yet it's very forceful on the opinion that long-acting stimulants are the first line treatment. It's egregious that there is such a shortage in the US.
I never noticed a significant difference between generic (and cheap) time-release dextroamphetamine (Dexedrine) spansules and Adderal, to the extent Dexedrine remains more available in terms of supply.
Dexedrine is the older drug and I gather it's thought to be easier to abuse, and so people are reluctant to write it/it's more tightly controlled than Adderal or Ritalin.
posted by snuffleupagus at 6:24 PM on August 26
I never noticed a significant difference between generic (and cheap) time-release dextroamphetamine (Dexedrine) spansules and Adderal, to the extent Dexedrine remains more available in terms of supply.
Dexedrine is the older drug and I gather it's thought to be easier to abuse, and so people are reluctant to write it/it's more tightly controlled than Adderal or Ritalin.
posted by snuffleupagus at 6:24 PM on August 26
The people responsible for this violence should be held accountable.
posted by ob1quixote at 6:50 PM on August 26 [2 favorites]
posted by ob1quixote at 6:50 PM on August 26 [2 favorites]
Weird timing.
Vyvanse and Adderall have both given me seizures in the past, so they're not an option for me. For the past several years, I've just been trying to push through via sheer willpower. That's become untenable in recent months. So I've been trying new medications.
Here's something that seems to work, at least for now: amantadine. It's mainly used to treat Parkinson's, but it also has stimulating effects. It doesn't provide as strong a "kick" as I remember from Adderall, but it also doesn't give me nearly as much anxiety.
The main downside that I can see is that it isn't nearly as well-studied as the typical stimulants, so I'm less sure of its safety profile. In fact, its use to treat ADHD seems to be quite new and still off-label, so I think I'm sort of acting like a human guinea pig. There's almost no anecdotal reports out there; I've had to rely on anecdotes from the nootropics community on bromantane, a related chemical.
It also seems to last a long time, so you have to find a dose that won't just constantly increase your levels. My doctor originally suggested 200mg a day, but I was getting very unpleasant side-effects at just 100mg.
posted by heraplem at 9:16 PM on August 26 [6 favorites]
Vyvanse and Adderall have both given me seizures in the past, so they're not an option for me. For the past several years, I've just been trying to push through via sheer willpower. That's become untenable in recent months. So I've been trying new medications.
Here's something that seems to work, at least for now: amantadine. It's mainly used to treat Parkinson's, but it also has stimulating effects. It doesn't provide as strong a "kick" as I remember from Adderall, but it also doesn't give me nearly as much anxiety.
The main downside that I can see is that it isn't nearly as well-studied as the typical stimulants, so I'm less sure of its safety profile. In fact, its use to treat ADHD seems to be quite new and still off-label, so I think I'm sort of acting like a human guinea pig. There's almost no anecdotal reports out there; I've had to rely on anecdotes from the nootropics community on bromantane, a related chemical.
It also seems to last a long time, so you have to find a dose that won't just constantly increase your levels. My doctor originally suggested 200mg a day, but I was getting very unpleasant side-effects at just 100mg.
posted by heraplem at 9:16 PM on August 26 [6 favorites]
(Also, in a cruel twist of fate, depression and ADHD are both common comorbidities for epilepsy, despite many medications for both increasing seizure risk.)
posted by heraplem at 9:49 PM on August 26 [2 favorites]
posted by heraplem at 9:49 PM on August 26 [2 favorites]
If you're reading this and thinking, well I don't have ADHD so this doesn't effect me, next time you're in a car (if you're American this will probably be later today) look around. No matter how good a driver you are, it doesn't matter when there are people behind the wheel on the road around you who have ADHD and are being affected by drug shortages.
This has been a PSA from someone who was a quiet, contentious honor student with undiagnosed ADHD who totaled a car (and someone else's in the process) in high school due to distraction (produced by my own brain, this was decades before cell phones) while driving home from working at the local grocery store.
I actually can't get Adderall at all because I live in Europe now, so dexamphetamine or Vyvanse are my only amphetamine-based options. And Adderall worked best for me, so that kinda sucks.
posted by antinomia at 3:34 AM on August 27 [3 favorites]
This has been a PSA from someone who was a quiet, contentious honor student with undiagnosed ADHD who totaled a car (and someone else's in the process) in high school due to distraction (produced by my own brain, this was decades before cell phones) while driving home from working at the local grocery store.
I actually can't get Adderall at all because I live in Europe now, so dexamphetamine or Vyvanse are my only amphetamine-based options. And Adderall worked best for me, so that kinda sucks.
posted by antinomia at 3:34 AM on August 27 [3 favorites]
I am curious if you have ADHD and have been prescribed provigil/modafinil and how did/does it work for you?
posted by seanmpuckett at 4:49 AM on August 27 [1 favorite]
posted by seanmpuckett at 4:49 AM on August 27 [1 favorite]
(The rules have actually been relaxed a bit since I was a pharmacy tech a decade ago: they used to require a paper prescription, but electronic prescriptions are allowed now.)
Ironically this made things somewhat worse for me - before, when a pharmacy was out of stock, I could just hop on the subway and go to the next one (and the next one, and the next one). With electronic prescriptions, my doctor's office has to be involved in that part as well.
posted by atbash at 7:24 AM on August 27 [1 favorite]
Ironically this made things somewhat worse for me - before, when a pharmacy was out of stock, I could just hop on the subway and go to the next one (and the next one, and the next one). With electronic prescriptions, my doctor's office has to be involved in that part as well.
posted by atbash at 7:24 AM on August 27 [1 favorite]
My kid had to stop taking stimulants for his ADHD a few months ago because they kicked some of his comorbidities into overdrive, but while he was on them, I was calling around to every pharmacy in town looking for his Focalin. Every single month. “Med vacations” on the weekends or over the summer simply weren’t an option because when he’s unmedicated he has zero situational awareness and will step in front of a bus. It’s exhausting.
The good news is he has been on amantadine for a few months now, and it definitely helps. He still can’t focus for shit, but at least he’s present. We’re also trying Qelbree, but it’s slow going. After three months of titrating up we still don’t know if it’s going to actually do anything for him.
posted by ValkoSipuliSuola at 8:53 AM on August 27 [1 favorite]
The good news is he has been on amantadine for a few months now, and it definitely helps. He still can’t focus for shit, but at least he’s present. We’re also trying Qelbree, but it’s slow going. After three months of titrating up we still don’t know if it’s going to actually do anything for him.
posted by ValkoSipuliSuola at 8:53 AM on August 27 [1 favorite]
Ritalin, and concerta. I have been getting both of these 90 days through the mail for.... I dunno, 7-8 years, at least?
Huh! I'm in California, and I've never been able to get ritalin through the mail, and it was just recently changed to 30 days instead of 90. I definitely got the impression from my doctor/pharmacist that it was federal rules in both cases. And in the case of the 30 days I had read a news story about the FDA planning it. I wish I knew how your provider was getting around it!
posted by tavella at 10:04 AM on August 28 [1 favorite]
Huh! I'm in California, and I've never been able to get ritalin through the mail, and it was just recently changed to 30 days instead of 90. I definitely got the impression from my doctor/pharmacist that it was federal rules in both cases. And in the case of the 30 days I had read a news story about the FDA planning it. I wish I knew how your provider was getting around it!
posted by tavella at 10:04 AM on August 28 [1 favorite]
Ha, called it. New York Codes, Rules and Regulations: Prescribing and Dispensing Controlled Substances
Section 80.67 - Schedule II and certain other substances
(d)(1) A practitioner may issue a prescription for up to a three month supply of a controlled substance, including chorionic gonadotropin, or up to a six month supply of an anabolic steroid if used in accordance with the directions for use, provided that the prescription has been issued for the treatment of:
(i) panic disorders, designated as code A;
(ii) attention deficit disorder, designated as code B;
(iii) chronic debilitating neurological conditions characterized as a movement disorder or exhibiting seizure, convulsive or spasm activity, designated as code C;
(iv) relief of pain in patients suffering from conditions or diseases known to be chronic or incurable, designated as code D;
(v) narcolepsy, designated as code E; or
(vi) hormone deficiency states in males, gynecologic conditions that are responsive to treatment with anabolic steroids or chorionic gonadotropin, metastatic breast cancer in women, anemia and angioedema, designated as code F.
posted by Iris Gambol at 11:25 AM on August 28
Section 80.67 - Schedule II and certain other substances
(d)(1) A practitioner may issue a prescription for up to a three month supply of a controlled substance, including chorionic gonadotropin, or up to a six month supply of an anabolic steroid if used in accordance with the directions for use, provided that the prescription has been issued for the treatment of:
(i) panic disorders, designated as code A;
(ii) attention deficit disorder, designated as code B;
(iii) chronic debilitating neurological conditions characterized as a movement disorder or exhibiting seizure, convulsive or spasm activity, designated as code C;
(iv) relief of pain in patients suffering from conditions or diseases known to be chronic or incurable, designated as code D;
(v) narcolepsy, designated as code E; or
(vi) hormone deficiency states in males, gynecologic conditions that are responsive to treatment with anabolic steroids or chorionic gonadotropin, metastatic breast cancer in women, anemia and angioedema, designated as code F.
posted by Iris Gambol at 11:25 AM on August 28
People who believe drug war rhetoric (so everyone working at the DEA) will never treat these meds as normal. If it could be used by a healthy person for fun, it’s assumed you must be an addict. When I was severely, suicidally depressed, a doctor who didn’t know me listened to me say “this medicine is literally the only thing keeping me from dying in the next 24 hours” and said “You should get off of it immediately. There’s addictive potential, and you could have urinary tract issues in 20 years.” They literally do not care if you die; the rejection of any drug that might alter consciousness, even therapeutically, is ideological. And we need to comport ourselves accordingly. Adderall’s not super-different on that score, and that’s unlikely to change anytime soon.
posted by vim876 at 8:28 AM on August 29 [5 favorites]
posted by vim876 at 8:28 AM on August 29 [5 favorites]
My state allows 90-day authorizations, but it seems like pharmacies will only dispense my ADHD med 30 pills at a time — my experience, anyway. I'm OK with this because it means I don't have to ask my NP to send my pharmacy a new prescription every month, but I'd love to get 90-day supplies of antidepressants and ADHD meds at the same time.
So far, I've only had to get my prescription filled elsewhere twice, but the first time it happened I was flat out of meds and forced to do that pharmacy scramble without having taken my meds that day. That took some doing.
posted by emelenjr at 10:43 AM on August 29
So far, I've only had to get my prescription filled elsewhere twice, but the first time it happened I was flat out of meds and forced to do that pharmacy scramble without having taken my meds that day. That took some doing.
posted by emelenjr at 10:43 AM on August 29
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My pills look different every month but I haven't had them miss a fill for me or any of my family members (a total of three entirely different stimulants + multiple different dosages between us) in the last year and half. Y particular hospital MMV but worth a shot.
posted by brook horse at 9:26 AM on August 26 [36 favorites]