Truepill.

[littlefred]

Did anyone use this pharmacy?

The DEA is alleging Truepill, Cerebral's former pharmacy partner, broke the law in filling prescriptions for highly regulated drugs

Truepill's might lose its ability to prescribe controlled substances. The DEA alleges it filled thousands of scripts for Adderall over two years.

www.businessinsider.com

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[mistafab]

Glad to see these bad actors getting brought to the fire

 

[Dr.MONO]

I believe these telepsych companies contributes to the adderall shortage.

 

[WisNeuro]

I believe these telepsych companies contributes to the adderall shortage.

While that may be a portion of it, a bigger issue is the underlying supply chain issues, combined with Teva having a worker shortage for a significant amount of time, switching of scripts to available meds, and caps on how much of a controlled drug any manufacturer can produce in a given time period.

 

[Dr.MONO]

While that may be a portion of it, a bigger issue is the underlying supply chain issues, combined with Teva having a worker shortage for a significant amount of time, switching of scripts to available meds, and caps on how much of a controlled drug any manufacturer can produce in a given time period.

I do not know. I have never seen that amount of people on Adderall or complaining of ADHD symptoms.

 

[littlefred]

I wonder what is the point prevalence of ADHD in the US vs other developed countries.
Also how much prescriptions of stimulants are given out in the US vs other countries.

Hope they lay down the hammer on these companies and use them as an example, but it won't likely happen.
A fine at best is all I see coming out of this.

 

[WisNeuro]

I wonder what is the point prevalence of ADHD in the US vs other developed countries.
Also how much prescriptions of stimulants are given out in the US vs other countries.

Hope they lay down the hammer on these companies and use them as an example, but it won't likely happen.
A fine at best is all I see coming out of this.

When they have matched symptom criteria and assessment methods, the rates have been similar in terms of diagnosis. Some very early studies had some differences, but they used different DSMs, usually 3 vs. 4) and variable assessment methods (some made purely by teacher report vs. multiple reports and clinical interview). Later worked looked at more robust diagnostic methods and the rates tightened up between countries.

 

[littlefred]

When they have matched symptom criteria and assessment methods, the rates have been similar in terms of diagnosis. Some very early studies had some differences, but they used different DSMs, usually 3 vs. 4) and variable assessment methods (some made purely by teacher report vs. multiple reports and clinical interview). Later worked looked at more robust diagnostic methods and the rates tightened up between countries.

Interesting. What about now with Cerebral, Done, Ahead etc and Ryan Haight being put on hold due to COVID-19 emergency declaration?

 

[WisNeuro]

Interesting. What about now with Cerebral, Done, Ahead etc and Ryan Haight being put on hold due to COVID-19 emergency declaration?

That is a different ballgame. Now you're asking about diagnoses made with no, or inadequate, evaluation being done. Which, from a theoretic standpoint, does not necessarily count as a diagnosis.

 

[littlefred]

That is a different ballgame. Now you're asking about diagnoses made with no, or inadequate, evaluation being done. Which, from a theoretic standpoint, does not necessarily count as a diagnosis.

I like your stance from a theoretic stand point, in the real world though a lot of prescribers are making bank doing crappy medicine. Their diagnosis is as good as yours unfortunately (billing purposes, prescribing, incidence/prevalence etc).

 

[WisNeuro]

I like your stance from a theoretic stand point, in the real world though a lot of prescribers are making bank doing crappy medicine. Their diagnosis is as good as yours unfortunately (billing purposes, prescribing, incidence/prevalence etc).

It's not a standpoint as it is just accuracy. Good epidemiological studies do "gold standard" type evaluations to make a diagnosis, as opposed to just data scraping diagnoses in a system medical chart. For example, we have studies where if you simply give a PCL or other PTSD sx self-report, you get a high rate of PTSD "diagnoses. However, if you do proper epidemiological research in the area, like the Breslau studies, we get an expected rate around 7.5-10% lifetime prevalence. So, it really depends on your question. Is the question "how many diagnoses of X have been made?" or is the question, "what is the prevalence of X in Y population?"

 

[forchinet121]

It's not a standpoint as it is just accuracy. Good epidemiological studies do "gold standard" type evaluations to make a diagnosis, as opposed to just data scraping diagnoses in a system medical chart. For example, we have studies where if you simply give a PCL or other PTSD sx self-report, you get a high rate of PTSD "diagnoses. However, if you do proper epidemiological research in the area, like the Breslau studies, we get an expected rate around 7.5-10% lifetime prevalence. So, it really depends on your question. Is the question "how many diagnoses of X have been made?" or is the question, "what is the prevalence of X in Y population?"

How are you finding out the prevalence of a diagnosis? Isn’t it based on if the community doctors have diagnosed those people? Where else would you get the diagnosis aside from chart review?

 

[WisNeuro]

How are you finding out the prevalence of a diagnosis? Isn’t it based on if the community doctors have diagnosed those people? Where else would you get the diagnosis aside from chart review?

Large epidemiological studies. They will sample a large number in different areas areas, perform diagnostic assessments, and generalize to the larger population based on that. These are fairly standard studies, particularly in MH. They just happen to be costly in terms of time and expense. These types of studies are what most of the prevalence stats in the DSM are based on.

 

[R. Matey]

I wonder what is the point prevalence of ADHD in the US vs other developed countries.

~6%, maybe lower. There aren't many meaningful differences by country. See the following (20-25):

The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder

Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we cu…

www.sciencedirect.com

 

[whopper]

I've complained about this in another thread. I've also had a sleep doctor tell me my conspiracy theory was true.

The theory being that most of the time, over 90% of my patients had a sleep problem once it wasn't OSA the sleep doctor pretty much abandoned them. "My sleep doctor told me I don't have OSA so there's nothing he's supposed to do."

When 1 patient tells you this that's one thing. When you have dozens all tell you the same thing something's going on. A colleague of mine told me that the big money in sleep medicine is only with OSA. So when the patient doesn't have OSA several sleep-doctors conveniently get rid of the patient.

Now where this affects me is that I have some patients with very severe sleep problems and it's out of my league. E.g. a patient that's tried all the Z-meds, TCAs, antipsychotics, Ramelteon, Belsomra, Alpha-Stimulation, sleep hygiene, avoid caffeine, etc, and he still can't sleep more than about 2 hours a night. OSA was already tested and negative and the sleep doctor told me to stop seeing him cause it's not OSA.

So given that I don't know what else to do, but no sleep doctor will touch his case and he's seen 3 so far. WTF. This is something they should handle not me.