Stimulant Prescription Epidemic

[drusso]

http://www.nytimes.com/2013/12/15/h...ttention-deficit-disorder.html?pagewanted=all

---

Members don't see this ad.

 

[101N]

Hmm, that sales curve looks familiar...

 

[drusso]

Hmm, that sales curve looks familiar...

No physical examination required, no objective imaging evidence of distractibility, no treatment adherence, REMS, nor compliance protocols...how many psychiatrists prescribing Adderall do flash pill counts?

 

[101N]

No physical examination required, no objective imaging evidence of distractibility, no treatment adherence, REMS, nor compliance protocols...how many psychiatrists prescribing Adderall do flash pill counts?

I think the lesson for the public is that a drug's sales slope indicates either a pandemic, or dam* good advertising.

 

[drusso]

I think the lesson for the public is that a drug's sales slope indicates either a pandemic, or dam* good advertising.

Maybe this has something to do with it...

http://www.science20.com/news_artic...ychiatrists_wont_take_health_insurance-126224

For Elites Only: Half Of Psychiatrists Won't Take Health Insurance

A standard joke among the elites of New York City And Los Angeles is that everyone is in therapy - it's possible because they are likely more rich and, it turns out, many psychiatrists are not interested in patients who aren't wealthy enough to not need to use insurance to pay.

But Congress, motivated by public outrage at recent mass shootings and their link to psychiatric medications, want mental health care to be covered by insurance and for psychiatrists to have the same standards as government-paid doctors have.

The paper found that psychiatrists increasingly refuse to accept Medicare and Medicaid, or even private insurance, as payment. In the five years between 2005 and 2010, investigators found that the percentage of psychiatrists who accepted private insurance dropped by 17 percent, to 55 percent, and those that took Medicare declined by almost 20 percent, also to about 55 percent. Their acceptance of Medicaid is 43 percent, the lowest among all medical fields.

"More than physicians in other specialties, psychiatrists accept lower rates of insurance, and those who don't take insurance are likely charging cash for their services," says the paper's lead author, Dr. Tara F. Bishop, an assistant professor in the Department of Public Health and Medicine at Weill Cornell Medical College.

 

[Aether2000]

.

 

[willabeast]

Free the restrooms, your minds will follow...

 

[PikminOC]

Are they equally as dangerous as opioids

 

[willabeast]

i used to know a beverly hills psychiatrist. his regular job was a work comp mill, but at his home in beverly hills he had a room where he saw patients, generally females between the ages of 20 and 40. sweet!

 

[SeniorWrangler]

Are they equally as dangerous as opioids

Well, you won't stop breathing due to stimulants. But they are very addictive and can cause mood swings, psychosis, violent and suicidal behavior when misused. They also have a big street value. And it definitely puts you in the liability crosshairs, see this article by a trial attorney:
https://www.justice.org/sections/ne...-wrongful-prescription-rabbit-hole-litigation

Our firm has a history representing clients whom have had adverse effects from medical devices and pharmaceutical products, by pursuing claims either in product liability or medical malpractice. Most recently our firm settled a very favorable claim for stimulant-induced psychosis that resulted when a treating psychiatrist prescribed three times (3x) the highest recommended dose of Adderall for a period of over a year.

Very similar to opioids, except that a pain doc can legitimately say that he doesn't feel comfortable prescribing stimulants and just say no.

 

[PikminOC]

Thanks! They are cracking hard on this

 

[powermd]

Thanks! They are cracking hard on this

Maybe you can explain the phenomenon we see when patients arrive on our doorstep on both amphetamines AND benzos. Looks like stepping on the gas and brakes at the same time with two very recreationally-oriented meds. Naturally these patients want opiates too if they're not already on them! This looks like unchecked chemical coping to me with an MD enabler.

 

[PikminOC]

I have a pt on both. Restless legs and adhd. We decided not to go with requip as we didn't want more dopamine increase as the stimulant is already doing that. Low dose xanax at night after stimulant has worn off. Xanax out of system before stimulant starts in am. Vyvanse in the am. Not very abusable. Middle aged man

This is only one of 3 of all my patients in have on both. Another one has severe social anxiety. On max dose of ssri as well. Doesn't want sga for obvious reasons.

Only one is opioids too from pain doc. I have pain doctors records as well. Therapy every 2 months.

 

[lobelsteve]

I have a pt on both. Restless legs and adhd. We decided not to go with requip as we didn't want more dopamine increase as the stimulant is already doing that. Low dose xanax at night after stimulant has worn off. Xanax out of system before stimulant starts in am. Vyvanse in the am. Not very abusable. Middle aged man

This is only one of 3 of all my patients in have on both. Another one has severe social anxiety. On max dose of ssri as well. Doesn't want sga for obvious reasons.

Only one is opioids too from pain doc. I have pain doctors records as well. Therapy every 2 months.

3 out of how many? I'm guessing less than 1%. We routinely see folks on 20mg bid amphetamine and 2mg tid Xanax.

 

[Ducttape]

not to quibble, but doesn't Xanax have a variable half life? the duration of effect may be 6 hours, but unless im mistaken, im reading some sites saying that the elimination half life is on average 12 hours, maybe up to 26?

 

[PikminOC]

0.5 mg. And he fills 30 every 6 weeks

 

[PikminOC]

3 out of how many? I'm guessing less than 1%. We routinely see folks on 20mg bid amphetamine and 2mg tid Xanax.

And a ton of alcohol to wash it down with. ..

 

[PainDrain]

Here is a typical pain patient in my area: mid 40s to 50s, disabled, smoker on a combo of Xanax, provigil, adderal, and oxycodone. The Xanax is for anxiety, the provigil is for "narcolepsy", adderal for ADHD and oxycodone for a "ruptured disc"(with a lumber MRI from 6 years ago showing mild disc bulges). And who is prescribing these life changing medications? Why it is their primary care/psychiatric nurse practitioner.

 

[drusso]

Here is a typical pain patient in my area: mid 40s to 50s, disabled, smoker on a combo of Xanax, provigil, adderal, and oxycodone. The Xanax is for anxiety, the provigil is for "narcolepsy", adderal for ADHD and oxycodone for a "ruptured disc"(with a lumber MRI from 6 years ago showing mild disc bulges). And who is prescribing these life changing medications? Why it is their primary care/psychiatric nurse practitioner.

Do have a mental health person to screen these patients before you see them?

 

[jettavr6]

3 out of how many? I'm guessing less than 1%. We routinely see folks on 20mg bid amphetamine and 2mg tid Xanax.

30% of my practice is adult general psychiatry. Many of these patients are ADHD. To be diagnosed, all other conditions need to be ruled out, including hypothyroid, depression, anxiety disorders, etc. Urine toxicology is performed. After that, they then need to go through about 3 hours of testing with our psychologist.

If they are diagnosed with ADD, then the default drug that I give is Adderall or Vyvanse. I do not allow the use of any Benzodiazepines or other sedatives concurrently with stimulant treatment, as it defeats the purpose. 20mg of adderall bid + Xanax 2mg tid = malpractice in my eyes.

 

[cbrons]

Here is a typical pain patient in my area: mid 40s to 50s, disabled, smoker on a combo of Xanax, provigil, adderal, and oxycodone. The Xanax is for anxiety, the provigil is for "narcolepsy", adderal for ADHD and oxycodone for a "ruptured disc"(with a lumber MRI from 6 years ago showing mild disc bulges). And who is prescribing these life changing medications? Why it is their primary care/psychiatric nurse practitioner.

Yeah they should never have allowed nurse practitioners or PAs to prescribe Schedule 2s. Even allowing them to prescribe benzos has been a fairly large disaster.

Sent from my SM-N910P using SDN mobile