15 ms·

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

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. Medication that actually works.

llbbdd 1y ago
Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.
- baby_souffle 1y ago
  > 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 discussion(s) from time to time on the latest action(s) taken by the DEA. --- When I was seeing medical help to confirm or refine my suspected/self-diagnosed ADHD, it was a _pain_ to jump through all the hoops. I was nervous getting my first Rx filled but oh my god was it a night and day difference. Within 45 min, it was _clear_ that the medication was working ... exactly how it's supposed to for people with ADHD. That "validation" was my prize for attempting to navigate the american health care system. If I could have replaced dozens of hours / 6+ months of phone-tag/paperwork/assessments for a monthly subscription and a 30 min video call, I'd have jumped at the chance.
  - skissane 1y ago
    > 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-medication-shortages 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-adhd-reforms-revealed https://www1.racgp.org.au/newsgp/clinical/first-phase-of-gp-...
    - Maxious 1y ago
      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_all_documents_relating_to_testing_the/ https://www.reddit.com/r/ausadhd/comments/1mhdmgs/foi_250162...
      - skissane 1y ago
        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.
      - wahern 1y ago
        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.
- adastra22 1y ago
  Circle is pretty easy to work with.
elcritch 1y ago
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 off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants. Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.
- pessimizer 1y ago
  [flagged]
  - gdbsjjdn 1y ago
    There's absolutely people who don't believe in any psychiatric medication, either for religious or just pseudo-scientific reasons. Look at how harshly the United States has treated marijuana users compared to smokers and alcoholics. There's moral and social judgement associated with different substances which is contingent on history and not based in fact.
  - elcritch 1y ago
    > (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-down-chevron-curtailing-power-of-federal-agencies/ https://www.scotusblog.com/2024/06/supreme-court-strikes-dow... 2: https://oversight.house.gov/wp-content/uploads/2024/05/Letter-to-DEA-drug-shortages.pdf https://oversight.house.gov/wp-content/uploads/2024/05/Lette... 3: https://www.bunkhistory.org/resources/the-cult-of-j-edgar-hoover https://www.bunkhistory.org/resources/the-cult-of-j-edgar-ho...
mandevil 1y ago
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.
- unethical_ban 1y ago
  You're right, and the situation is a harm to those who need adderall. Besides, adderall is not nearly as dangerous as Opiods. Whoopty-doo if it's diet Coke. This is why, even though I don't like Adderall's side effects for my ADHD and don't use it often, I keep the prescription, because fuck the government trying to squeeze pharmacists and doctors.
  - LoganDark 1y ago
    Yep. No matter how long I've been taking my ADHD meds, I can just stop them at any time. I'll sleep for a while (I think my record is 25 hours of sleep), but that's it. No life-threatening withdrawals. No panic. No pain. Safer than any opioid (except perhaps naloxone?).
    - mithametacs 1y ago
      The withdrawals are fucking garbage from even mild abuse (3x prescribed). I passed out and cut my head. And was anhedonic. And lethargic. And I started taking it as an adult. So I had 4 or 5 ADHD diagnoses under my belt.
  - chipsrafferty 1y ago
abtinf 1y ago
> she’s actually really reasonable and I like her From what you’ve written, she didn’t treat your actual condition and thus put you through needless suffering and placed your health at risk.

llbbdd 1y ago

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

baby_souffle 1y ago
> 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 discussion(s) from time to time on the latest action(s) taken by the DEA. --- When I was seeing medical help to confirm or refine my suspected/self-diagnosed ADHD, it was a _pain_ to jump through all the hoops. I was nervous getting my first Rx filled but oh my god was it a night and day difference. Within 45 min, it was _clear_ that the medication was working ... exactly how it's supposed to for people with ADHD. That "validation" was my prize for attempting to navigate the american health care system. If I could have replaced dozens of hours / 6+ months of phone-tag/paperwork/assessments for a monthly subscription and a 30 min video call, I'd have jumped at the chance.
- skissane 1y ago
  > 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-medication-shortages 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-adhd-reforms-revealed https://www1.racgp.org.au/newsgp/clinical/first-phase-of-gp-...
  - Maxious 1y ago
    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_all_documents_relating_to_testing_the/ https://www.reddit.com/r/ausadhd/comments/1mhdmgs/foi_250162...
    - skissane 1y ago
      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.
    - wahern 1y ago
      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.
adastra22 1y ago
Circle is pretty easy to work with.

elcritch 1y ago

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 off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants. Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.

pessimizer 1y ago
[flagged]
- gdbsjjdn 1y ago
  There's absolutely people who don't believe in any psychiatric medication, either for religious or just pseudo-scientific reasons. Look at how harshly the United States has treated marijuana users compared to smokers and alcoholics. There's moral and social judgement associated with different substances which is contingent on history and not based in fact.
- elcritch 1y ago
  > (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-down-chevron-curtailing-power-of-federal-agencies/ https://www.scotusblog.com/2024/06/supreme-court-strikes-dow... 2: https://oversight.house.gov/wp-content/uploads/2024/05/Letter-to-DEA-drug-shortages.pdf https://oversight.house.gov/wp-content/uploads/2024/05/Lette... 3: https://www.bunkhistory.org/resources/the-cult-of-j-edgar-hoover https://www.bunkhistory.org/resources/the-cult-of-j-edgar-ho...

mandevil 1y ago

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.

unethical_ban 1y ago
You're right, and the situation is a harm to those who need adderall. Besides, adderall is not nearly as dangerous as Opiods. Whoopty-doo if it's diet Coke. This is why, even though I don't like Adderall's side effects for my ADHD and don't use it often, I keep the prescription, because fuck the government trying to squeeze pharmacists and doctors.
- LoganDark 1y ago
  Yep. No matter how long I've been taking my ADHD meds, I can just stop them at any time. I'll sleep for a while (I think my record is 25 hours of sleep), but that's it. No life-threatening withdrawals. No panic. No pain. Safer than any opioid (except perhaps naloxone?).
  - mithametacs 1y ago
    The withdrawals are fucking garbage from even mild abuse (3x prescribed). I passed out and cut my head. And was anhedonic. And lethargic. And I started taking it as an adult. So I had 4 or 5 ADHD diagnoses under my belt.
- chipsrafferty 1y ago

abtinf 1y ago

> she’s actually really reasonable and I like her From what you’ve written, she didn’t treat your actual condition and thus put you through needless suffering and placed your health at risk.