ADHD drug treatment and risk of negative events and outcomes

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

I was on a 90 day prescription for ten years (vyvanse) when I told my doctor I was traveling abroad.

Insurance doesn’t cover 90 day bottles so it was $300/mo but worth it.

Nowadays there’s generic Vyvanse which is much cheaper so it probably makes 90 day prescriptions financially viable?

I just moved back to the US and had to find a new local doctor who gives me 30 day scripts so I haven’t asked about 90 day yet. I imagine these pill mills are pretty stingy. It takes a lot of time and calling around to find docs who don’t treat you like a fiend in some way.

But we need to count our blessings. People on pain killers need to put up with crazy shit like getting randomly summoned to the office so they can count your remaining pills.

Not to make light of your situation, but women taking birth control have been in this situation forever.

It is only recently that over the counter birth control and/or three month allotments have been available.

Since you may sell them if you get them more frequently. Now here's a pack of 30.

At least with time release now there's less of a problem of having to sneak to the nurse's office every day at lunch to take medication and have that brat from third period ask you why you're in the nurse's office and what you're taking.

It’s the same thing for me and Klonopin and my psychosis. The Klonopin is the only thing that stops my psychosis yet they only give me 20 tablets at a time and since I’m homeless and driving around it’s really hard for me to get a new doctor and a new prescription. I’ve been taking it as needed for over nine years and they still can’t get it through their thick heads that I’m not gonna abuse it.

Yep. For a while there I was able to work with my doctor and pharmacist to get Adderall from my Kaiser health plan pharmacy in 90 day increments but that stopped with the med shortage. But now that the shortage is over they won't do it again. I haven't been able to figure out if this is an actual regulation change due to the shortage or just a health plan policy change. If it's a reg change, it'll never go away. If it's a health plan policy, maybe there's hope.

The problem is that Schedule 3 meds can't be shipped and must be picked up in person at the pharmacy (where driver's license must be entered in an extra procedure not required for other meds). Health plan pharmacies have lines, don't have drug store hours and aren't on every corner. The combo of "in person pickup" + "30 day limit", which were enacted by different people at different times for different reasons creates life disruption and a massive waste of time, energy and money (we're all paying for this in increased prices). I've been on these same meds like clockwork for decades. In such cases they should relax either "in person pickup" or "30 day limit" but, we all know, it won't happen.

And if I need to travel on a trip or vacation for a week or two, with a 30-day limit there's a 25-50% chance I'll run out of meds and getting special dispensation to refill early requires contacting and coordinating the doctor and pharmacist in a non-automated, out-of-band loop. There's a two day automatic grace period to account for the pharmacy being closed on weekends but when my 30-day window falls on a weekend, I now have to coordinate pickup on an exact day - like I don't have a life outside of this bullshit. All just to get the meds which help me function normally.

Being forced to deal with all this for years has made it so I understand the health plan's back-end IT system capabilities (and lack thereof) better than most of their employees. It's still inconvenient for me but I'm one of the lucky ones. My meds are dialed-in and working, I have a flexible schedule and can parse bureaucratic systems. I got diagnosed and stable on my meds back before every ADHD patient was automatically considered a suspected drug abuser - which is ironic because I've never even had a drink, much less used illicit drugs or been high (ADHD and alcohol/rec drugs tend not to mix well and I was diagnosed as a child). It's meta-ironic I'm required to have a drug screen blood test every year to verify I am taking my prescribed drugs (as opposed to selling them), like I got diagnosed in 4th grade as the ultimate long con to get $30/mo 40 yrs later. I can't imagine a new ADHD patient still struggling to find the right med and dosage trying to figure all this out without giving up.

> I've heard it argued that ADHD diagnoses should come with a social worker.

I know a few people with crippling ADHD that have managed to hire a "life coach" of sorts to help. Takes a bit of screening to find somebody that knows ADHD and how to help with it versus the more generic/useless skills you probably first thought of when you read 'life coach' :).

> Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that.

We all have to develop our own coping / survival tools and I'm sure you've heard "put it in your calendar" before. I've had really good luck with an electronic pill dispenser. They can get pricey but for ~ $100 you can get a device that'll keep track of 30 doses and even push alerts to your phone if you've missed a scheduled dose or are down to your last few. You can also DIY; micro controllers and eInk display panels are _cheap_ now. My current iteration is wired into my Home Automation system and that affords me several opportunities to nudge me towards medication when i'd have otherwise forgotten.

> One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.

Yep. +1 for this. The first prescribing psych that I had clued me into this. They explicitly asked me if I wanted a bump to my Rx for the month so I could start building a buffer. I was clueless but it was explained to me that there's a bunch of timers and rules around how/when you can re-fill and you might not always have a continuous supply unless you take matters into your own hands. Years later, I now live in an area where fire season is almost year-round and you can bet that I have ~ 2 weeks supply stashed away in my "go bag".

I'm of course not recommending or condoning this, but with instant release it's definitely possible to also get a higher dosage than you actually need and cut the pills up to take the lower dosage you need, and stash the rest to build up a surplus.

Or so I've heard.

Yes, knowing about RSD was life changing for me.

Before I had my ADHD diagnosis, I just assumed that I have social anxiety and tried to fix it myself by giving me exposure therapy. I would force myself to seek out any social interaction regardless on how I felt.

The result was that I got worse, so much worse because I was basically trained myself to disregard my emotions. Turns out being undiagnosed with ADHD is traumatizing. I did not imagine that people hated me for being different, I never had any phobia. It wasn't "just in my head". The truth is that I am different and lots of people will instinctively hate me for being neurodivergent. I just needed to learn to deal with that.

That is why a correct diagnosis is so important. I despise that people are given generic diagnosis like depression or anxiety instead of digging deeper and trying to find out what actually causes them.

Same as me. I think about it every day now. I’m 44 and It explains a lot of my behaviours.

I found the adhd chatter podcast very helpful

https://youtube.com/@adhd_chatter_podcast?si=Ne0isYQ2QCgIeqY...

I just go through GoodRx now, makes it like $20 per month for my prescription. You don't even need to make an account with them, it's like coupon you don't even need to print out. Just tell the pharmacist you are going to use GoodRx and you are done.

My work insurance seems to change all the time, and while going through GoodRx doesn't count towards my deductible, I prefer the price stability. Not fun when I'm randomly told it's $120 now at the pharmacy because my insurance doesn't cover it now for some fucking inane reason. A few phone calls can often resolve it, but it's the last thing I want to do when I'm a day away from withdrawals kicking in. Even more absurd is this is basically guaranteed to happen more than once a year, THERE IS ONLY 12 MONTHS IN A YEAR!

What does the DEA have to do with US health insurance, exactly?

The hoops I have to jump through for a prescription I’ve been on for multiple years is ridiculous. My insurance will wrongly think I’ve filled it at a CVS I sent the script to hoping they’d have it in stock and then I sometimes end up paying out of pocket because otherwise I am exhausted all day and have limited capacity to do tasks.

The meds themselves have dramatically improved my life by being more capable of getting tasks and work done. Main downside is the drop off around 8/9pm when I become really tired and unfocused.

I’ve only taken it once.

I woke up feeling sick, stiff, and lethargic while staying with a friend in NYC in 2008. My friend said “I’ve got just the thing” and gave me one of his adderall.

20 minutes later I was feeling better than I’ve ever felt in my life. We had one of the most exciting, memorable days in my life, just pinging all over the city. That night we went out to a club, where I somehow charmed a girl way out of my league.

We met up the next day and she was very disappointed.

That is to say, it was quite pleasant for me.

I sometimes think I have undiagnosed ADHD (my daughter has it), but this would seem like evidence against it, as it was undeniably stimulating.

> I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood.

Years before I was diagnosed with ADHD, I was offered some cocaine. It did not effect me like everybody else. I assume that it's a similar deal with adderal. You and I are who the medication is _meant_ for. For more neurotypical people, it's not a "leveling" effect, it's - apparently - an elation.

I think especially as adults (esp. people that managed to get to adulthood without being diagnosed), a lot of people think they don't have certain symptoms, when really they just have developed elaborate systems for managing those symptoms.

I never related to "time blindness" because I was always consistently early for things, but really I was just deeply anxious about being on time for things. I would set like 10 alarms set, I wouldn't be able to do anything for an hour or two beforehand because I was worried about being late, and I'd usually show up way too early because I couldn't actually estimate when I needed to start getting ready to be on time. That doesn't exactly sound like the behavior of someone with a functional inner clock.

I'm not familiar with the reaction time test. Based on some reading I've done, ADHD is associated with higher variance in reaction time. Despite my ADHD symptoms, I've never thought reaction time was one of them. Quite the opposite really. The hours and hours honing my "skills" in first person shooters puts my reaction time and precision well above human average. But basically the only time I'm testing my reaction speeds is when headed towards those ADHD hits. The few times I've had opportunity to test it, it's felt very "game like" in science centers and places like that and I still have consistently fast reaction times.

The "clumsy" aspect is similar. I'm not clumsy. My balance and coordination are a little above average based on observations like rock hopping to cross streams while hiking.

My understanding is that motor coordination is a mostly separate issue from attention regulation and task completion, so it would make sense that a stimulant would address focus and impulsivity (as well as suicidality and criminality by proxy of those) but not clumsiness. Also, one can have ADHD without being clumsy, but being clumsy alone does not quality for ADHD.

I could be completely wrong, but hopefully that explains my take better. I'd be happy for someone to correct me.

My hypothesis - body awareness and injury avoidance is learned and ADHD folks have a less effective reward loop. While the meds help with the reward loop, the person has decades of catching up to do for body awareness.

ADHD is strongly associated with inattentiveness and daydreaming so it's not that surprising that people who are daydreaming or not paying attention tend to get injured walking or driving into thinks more often

My meds have me on the ball from about 9am - 5pm. Outside that window I wouldn't trust myself flying a plane unless it was an unusual flight, like flying a new aircraft or flying into a storm, or on a rescue helicopter landing on a highway or mountain. The more routine the more dangerous it gets which is not ideal for your average pilot :-(

Pilot licences and any mental health issues seem to be a massive pain in general. Lots of people will avoid treatment/diagnosis to not get affected. Xyla has a video on it https://youtu.be/aj0H8oVS7qg + the Pilot Mental Health Campaign.

What a terrible policy. I sure don't feel any safer knowing that my pilot could have problems going untreated. Just getting licensed seems like it would be difficult without treatment, but it's not like ADHD or other mental conditions are consistent either. You can have good or bad days, or even good/bad months. Those times can be handled with treatment, but I guess we're just supposed to hope our pilot isn't having a bad day when we get on the plane.

> Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.

Yeah, it's an issue! To the best of my understanding, it's not a mark against you if you have had treatment in the past. You can't have a valid license and be taking active treatment, though.

How do you feel after those drives of a few hours?

I have driven up to 6 hours at a time, but I'm in hyper-focus mode the whole time and it takes everything I have to stay locked into that focus so I don't die. I think all the time about moving somewhere where I don't need a car. I hate driving and always have.

I recently found out I have ADHD. I haven't tried meds yet (but am having my first meeting with someone tomorrow to explore it as an option). I'm wondering if this will make driving more tolerable for me. It wasn't even something I thought about before this thread.

I have considered it, but in proper ADHD fashion I completely forgot to follow up. Thank you for the reminder that I should go get tested for that while I am still on my medical leave

> I also think even without the medication the diagnosis is worth it.

Yeah, I think our society views so many symptoms of ADHD as the worst type of personal failings, so I think there's a level of trauma associated with growing up undiagnosed and being consistently blamed and shamed for things that were out of your control. Even without medication, getting diagnosed was, for me, the first step towards healing and starting to unpack all that shame.