Is Adderall really less addictive/divertable than Dexedrine?

[YumIsPeople]

This was the justification someone gave me once for the predominance of Adderall over Dexedrine. It seems like Dexedrine has less severe stimulant side-effects, which I understand is part of why it's considered to have more of an abuse liability (I think), but it does not seem—at all—to actually be abused more. It seems like patients request Adderall way more than Dexedrine based on what I hear docs say, and I feel like Dexedrine will be less likely to be diverted than Adderall. (Well, once they see the word "Dextroamphetamine" on the bottle, that probably goes up, but it will probably still be less than if they knew they have the infamous Adderall. )

I guess I just wonder why Dexedrine has a more favorable side-effect profile, but it is not prescribed nearly as much as Adderall. Of course, I suppose Vyvanse would be best, but that is not really an option at times for cost reasons.

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[splik]

no of course not. the triumph of Adderall is the triumph or marketing. it was initially developed for weight loss but got pulled (and of course now vyvanse is trying to cash in on the weight loss market by rebranding it as "binge-eating disorder"). Adderall literally means ADD for All. Shire has managed to convince everyone that they have ADHD (including adults) and their campaign has been very successful.

 

[TexasPhysician]

Why am I not getting more requests for Desoxyn?

 

[splik]

because you can make/buy meth for much cheaper on the streets (insurance is unlikely to cover it)

 

[YumIsPeople]

no of course not. the triumph of Adderall is the triumph or marketing. it was initially developed for weight loss but got pulled (and of course now vyvanse is trying to cash in on the weight loss market by rebranding it as "binge-eating disorder"). Adderall literally means ADD for All. Shire has managed to convince everyone that they have ADHD (including adults) and their campaign has been very successful.

Yeah, that's definitely my opinion too. What I have always thought about it is that physicians, even if they are going to be prescribing tons of stimulants, could at the very least prescribe the cheapest ones and not tax the healthcare system financially. The additional cost of all of those (then on-brand) Adderall and Adderall XR rxs over the (generic) Dexedrine and Dexedrine Spansules rxs in the 90s and 00s must have been insane.

 

[hamstergang]

At this point in time, prescribing dexedrine is a pain as not many pharmacies (in my area, at least) carry it.

 

[Jules A]

The qualifier less addictive/divertible is splitting hairs. They are all abusable/divertible/addictive. Ask an adolescent with substance abuse problem how to liquify Vyvanse. While there are definitely some that have a higher street value but to feel smug that we have prescribed something less abusable is laughable. On a side note I recently heard a psychiatrist speak on anxiety who actually said Klonopin isn't abusable.

 

[SeniorWrangler]

The qualifier less addictive/divertible is splitting hairs. They are all abusable/divertible/addictive. Ask an adolescent with substance abuse problem how to liquify Vyvanse. While there are definitely some that have a higher street value but to feel smug that we have prescribed something less abusable is laughable. On a side note I recently heard a psychiatrist speak on anxiety who actually said Klonopin isn't abusable.

Vyvanse is a prodrug, how does liquifying it make it more abusable than it was already?
My understanding is that liquifying it is a way of titrating the dose more precisely than the pills allow.
EDIT: Here's a study claiming that IV Vyvanse was not preferred over placebo by substance abusers: http://jop.sagepub.com/content/early/2008/07/17/0269881108093841.short

 

[Jules A]

Vyvanse is a prodrug, how does liquifying it make it more abusable than it was already?
My understanding is that liquifying it is a way of titrating the dose more precisely than the pills allow.
EDIT: Here's a study claiming that IV Vyvanse was not preferred over placebo by substance abusers: http://jop.sagepub.com/content/early/2008/07/17/0269881108093841.short

I don't think liquifying it makes it any more abusable although I do believe it is fairly common likely more with kids than the more sophisticated substance abusers. Unfortunate if as your link indicates they are risking all the nasties of IV drug use without any additional gain.

 

[HarryMTieboutMD]

Adderall is also the most sought after academic steroid among undergrads/med students/law students (I think there is literature on this as well), and yeah I agree marketing plays a huge role. When I was an undergrad methylphenidate was seen as a consolation...
In last month's American Journal of Psychiatry there were a couple of longitudinal studies looking at Adult ADHD which interestingly showed that most of the subjects had subsyndromal symptoms in childhood but the "disorder" manifested itself once the scaffolding/structure of being reared went away... (now how to interpret this is very much open...)

 

[SomeDoc]

Adderall is also the most sought after academic steroid among undergrads/med students/law students (I think there is literature on this as well), and yeah I agree marketing plays a huge role. When I was an undergrad methylphenidate was seen as a consolation...
In last month's American Journal of Psychiatry there were a couple of longitudinal studies looking at Adult ADHD which interestingly showed that most of the subjects had subsyndromal symptoms in childhood but the "disorder" manifested itself once the scaffolding/structure of being reared went away... (now how to interpret this is very much open...)

There are a several recent studies that highlight the issue in medical students, this is one, for example:
http://www.ncbi.nlm.nih.gov/pubmed/23376867

State-dependent learning, and a potential for relaxed attitudes towards prescribing stimulants to patients are some potential concerning issues

 

[Shikima]

no of course not. the triumph of Adderall is the triumph or marketing. it was initially developed for weight loss but got pulled (and of course now vyvanse is trying to cash in on the weight loss market by rebranding it as "binge-eating disorder"). Adderall literally means ADD for All. Shire has managed to convince everyone that they have ADHD (including adults) and their campaign has been very successful.

Pain is the 5th vital sign?

 

[SeniorWrangler]

Concentration is the 6th vital sign. If you tuned out before we got to #6, then you have ADHD.

 

[Shikima]

Concentration is the 6th vital sign. If you tuned out before we got to #6, then you have ADHD.

 

[DD214_DOC]

I have been on both sides of the ADHD thing. Honestly, having been a patient really does make you a better clinician, for what it's worth. This stuff is much more complicated than the DSM suggests, and to be an astute clinician, you have to go beyond mere descriptive psychiatry. Many neglect the importance of considering functional and intellectual capacity when evaluating for ADHD. A gifted individual may have symptoms, but may not demonstrate any significant impairment for years, despite a subjective sense of being, "impaired". The impaired performance of someone with an IQ of 142 is likely to still be considerably better, or nearly identical, to the unimpaired performance of someone with an average or above average intellectual ability. It is not until this individual's, "raw intellectual ability", no longer suffices on its own; meaning, intellect can no longer compensate for a deficit in attention, organization, and planning. It is at this point where dysfunction or impairment may first manifest, although it has always been there to some degree. Teasing out these details can be very, very difficult, and it takes a considerable amount of time. This incredibly-small population of patients also have to work against an enormous amount of bias and, for many, lack of really understanding ADHD as a syndrome, amongst providers.

There is a reason why the DSM5 specifically indicates that, for a diagnosis, only symptoms need be present prior to age 12 -- not dysfunction or impairment. This is probably the most important point to keep in mind. Symptoms always start in childhood, never adulthood. Dysfunction can start at any time.

All of this should be considered within the context of the individual patient seated before you. If someone of average intellect claims to have been symptomatic without dysfunction or impairment until they started College, professional school, or work, it's less likely than if this was a gifted person who had no need to pay attention or study.

 

[Information Underload]

My understanding is that Adderall (75% D-Amphetamine and 25% L-Amphetamine) should typically have a slightly lower abuse potential than Dexedrine (100% D-Amphetamine) given that L-amphetamine is a less potent releaser of dopamine and a less potent re-uptake inhibitor and is a more potent releaser of norepinephrine. Whether that actually amounts to anything clinically is doubtful, IMHO. I have heard users on the street prefer Dexedrine of the two, but we know how reliable those stories are...

Also, from a cost perspective, generic isn't always cheaper with stimulants. Vyvanse, for instance, is less expensive than Dexedrine Spanules in my area on GoodRx. Generic Adderall XR is less expensive, but if you throw in a Vyvanse discount card, it no longer is. These extended release stimulants really haven't decreased in price much once they have gone generic, which is frustrating. You can't even cut them in half like you can SGAs.