Does anyone know the total number of scripts once the online pill mills started versus the number produced (I know there were supply chain disruptions with the production) versus the change related to that settlement? I would love to see some sources or data, particularly on the increase in psychostim Rxes.
Do you have any articles about what exactly is taking place legally and the rationale behind it? I'd love to read more. But also want to reference other providers in this office (especially those who do not prescribe) about what is going on in this country with the term of ADHD and role of stimulants good and bad. I don't think those who are not involved in prescribing are aware of what diagnosing ADHD fully means and that it is not a panacea. Medication management, especially controlled substances is complex. And we are dealing now with these new logistical factors. So before we get people's hopes up that "it was all ADHD and let's look at med options," let's be careful about how we deliver our care and what we can find that will longitudinally be helpful.
Another front in 'The War on Drugs,' I suppose...soon to be followed by 'The War on Supply Chain Disruptions,' I'm sure.
Much appreciated the info until I fell into the horrifying rabbit hole of John Q Public’s’ comments.Xanax and Adderall Access Is Being Blocked by Secret Drug Limits - Slashdot
Patients diagnosed with conditions like anxiety and sleep disorders have become caught in the crosshairs of America's opioid crisis, as secret policies mandated by a national opioid settlement have turned filling legitimate prescriptions into a major headache. Bloomberg reports: In July, limits...science.slashdot.org
Secret limits to stop 'suspicious' Xanax and Adderall orders are forcing some legitimate patients to scramble
Independent pharmacists said the rules force them come up with creative workarounds.fortune.com
Glad you had that info but I would expect a real ramp up to be more in the 2021 and 2022 years as it took some time for the NP/venture cap pill mills to come online with the suspension of Ryan Haight for COVID.
yep it was more/continued increase, lol. But that just shows the nice start, the trend only got worse.
Better off with Focalin XR + Focalin IR PRN qafter school for most kids anyway. If we had a real OROS system with generic Concerta it would be a different story. Stimulants with sustained releases that do not create spikes are just inferior for most patients. I think it can hard for some patients and even doctors to understand this concept as we are so trained to want stable blood levels and low max levels with most of our medications.
I don't think a single person in this entire thread (or on this forum) was saying anything in disagreement with what you said about adult onset ADHD. The majority of the discussion has been about ensuring some stability for our patients who are suffering due to this shortage and attempts to come up with solutions. Your comment here seems a bit out of place.
They were real quick starting up.
My admittedly limited knowledge speaking as a family doctor, I thought concert is outer layer was immediate release methylphenidate and the inner part was the more sustained release part.
Concerta branded is an immediate release (just under 1/3 of the mg listed) followed by an osmotic pump that releases two seperate times. It is effectively taking Ritalin immediately, then Ritalin again 3-4 hours later then again 3-4 later. The magic in the technology is that it provides the spike in stimulant level on 3 occasions with only needing to take the one pill which is great for convenience and adherence.
TBH I hadn't heard anyone talk about the spikiness being preferable in this way before. Is there a theorized mechanism for that benefit? Patient's "notice" that they took it several times? Ramp in DA action is more important than tonic action? Probably the one class of meds that many adult psych residencies do not teach in sufficient detail.
Yes I don't have the research in front of me now but my attending in fellowship sat in a lot of the FDA approvals for psychostimulants. We were trained to basically never using long acting Ritalin (Metadate CD is better but has a wonky release where less is IR and more releases later), Focalin XR and Adderall XR are perfectly biphasic release (1/2 IR, 1/2 released 3.5-4 hours later). Concerta is the only triphasic. I generally do not like Vyvanse because of it's gradual release. This is also a concern with the new QHS stimulant.
It was self-effacing humor, trust me I have plenty of confidence in my medical knowledge (probably more than is justified if I'm being honest).
Psychostimulants have more weird believes attached to them than any other class of meds
Absolutely correct, Ritalin LA is totally fine, although I would typically prefer Focalin XR in nearly every instance. It was very hard to find LA and mostly saw patients on SR.
A "bit out of place"? So, for all of you prescribing stimulants to adults and making money on it, considering your ethics is "in place" in my mind. If there is a shortage, maybe it is because there is an epidemic we are contributing to. Pulling out your pen and writing DA agonists for patients wanting this who happen to be sitting in front of you just get stimulants and your complacency in doing so isn't helping our credibility. I'm not a bit out of place, but right in the place more of us should be.
As I was reading about the regulations addressing stims, benzos and opiates...I agree it also frustrates me. As you said, there are legit individuals who need these medications. It broke my heart to read that hospice patients have a challenge getting access to their medications and amplifies my countertransference more. Although...in a situation like that, I'd hope someone can find a relatively straightforward solution where there's a different level of access to hospice patients--hospice patients are easy to identify because they get enrolled in a program and/or their insurance changes their designation of the patient. I've encountered this through medical billing.
The real pros are writing Adderall 30mg IR TID so that is easily $900 at 10 bucks per pill which is honestly on the low end of an Adderall 30mg IR price around me.
From the stimulant UD patient's I have seen, it's around $10-20 for a 30mg tab around me. Depends on how many you are buying, if you want to see a full Rx bottle with a date that was just filled, etc.
"Abortion is a little different situation for me. That is another human life being affected and America's history of Planned Parenthood is rooted in eugenics and racism against my people. However making abortion less accessible increases crime rates in the long run and also increases the amount of left leaning citizens which also increases crime rates/civil unrest/alt left terrorism/extremism. I cannot quite figure out where I stand in this matter." -ChudsMgee
So...so many things get confused, conflated, or lost in these conversations.
I won't even prescribe medication to people that come into my office that didn't have symptoms before the age of 12 but are younger than 18. ADHD is a neurodevelopmental disease. If you didn't have difficulty functioning before age 12 in more than one environment, you don't have ADHD. What is frustrating for me is that all of these adults getting meds they probably don't need has made it impossible for me to fill prescriptions for kids that absolutely cannot function to the point they often represent a risk of harm to themselves or others when they're unmedicated.
hahahahahahahaha /cinemasinsjeremy
Completely agree, unfortunately we live in an era where said guy can hurt your income/job prospects with negative reviews. You did the right thing but I can understand why people don't.
any recommendations for articles to cite about the ASRS and validity/specificity? It's a nightmare when clinicians use that, patients are pan positive, and they take the ASRS word for it that it must be ADHD. The specificity is terrible.
I think this can be said for a lot of our diagnoses and attentional difficulties is probably the worst culprit.
Do you think this is true even for classic (childhood) diagnosis of ADHD?
This is a joke right?
Very real. They got it wrong.
Yes, because children are products of their environment. Typically poor sleep, poor discipline, poor parenting and poor academic environments are quick to label ADHD rather than modify and change the area which they live in.
