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You keep giving Adderall to my son, you're going to kill him
February 4, 2013 5:06 PM   Subscribe

Drowned in a Stream of Prescriptions. NYTimes link. From the article: "The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said." Trigger warning: addiction, suicide.
posted by sweetkid (52 comments total) 22 users marked this as a favorite

 
This was an absolutely horrifying story. The parents repeatedly try to get help, to get the professionals to pay attention, and could not. I cannot imagine being in those circumstances. Imagine, thinking to yourself, "I've searched all over for my suicidal son. Oh, wait. What about the closet?"
Absolutely heartbreaking.
posted by etaoin at 5:22 PM on February 4, 2013


Geez, they make it sound so easy... How did this kid breeze past the hoops my insurance makes me jump through every time I get my prescription refilled?
posted by redsparkler at 5:25 PM on February 4, 2013 [8 favorites]


[Folks. This is a difficult topic. Your comments about who you don't care about are completely unhelpful, non-interactive and derailing. Try again please?]
posted by jessamyn at 5:36 PM on February 4, 2013 [9 favorites]


I was wondering when this would get posted. Utterly heartbreaking.
posted by computech_apolloniajames at 5:49 PM on February 4, 2013


Redsparkler, I know what you're saying. My son has been on stimulants for ADHD for 12 years, and we have had to to go through so much rigmarole every month to fill each prescription. My son has been on Adderal, Ritalin, Concerta and Vyvanse, and he has never once described feeling good on any of them, just feeling like he is able to think clearly.

I feel for this family. There has to be a better way. Massachusetts, where I live, doesn't seem to make it as easy to get these meds.
posted by Biblio at 5:52 PM on February 4, 2013


I am trying to balance my tremendous feelings of sadness for this poor young man and his family with my mounting dread knowing that most of the nuance in this story won't survive retelling. It'll just be used as another example of how ADD is all just doctors overdiagnosing and how ADD is just a scam. I'll try to explain about what life is like for those of who have the damned thing and how these drugs make life plausible for a lot of good people having a hard time, but it'll just be so much noise.
posted by DirtyOldTown at 5:54 PM on February 4, 2013 [18 favorites]


Pharma as the dopeman: While the gov't treats cocaine and crystal meth as narcotics, the drug companies add methyl groups to each and call them concerta and adderall. If you are addicted to adderall, you are addicted to crystal meth -- concerta, cocaine.

This is terrible. I don't think his parents really know what he was dealing with.
posted by Silo004 at 5:55 PM on February 4, 2013 [3 favorites]


It'll just be used an another example of how ADD is all just doctors overdiagnosing and how ADD is just a scam.

I actually was sensitive to this when posting this story, because I fully believe these drugs help people, and as someone who was helped by depression/anxiety medications I understand the exhaustion and frustration of people saying money-hungry doctors are driving the drug machine or whatever. There is a lot of nuance in the story though which is what I found so interesting. There is a lot of attention paid to perhaps not the best prescribing practices, but many of the doctors mention how Richard would somehow seem so convincing and capable and could convince anyone of his need - not blaming the victim here, but it was just interesting to imagine how his specific personality and high social skills could have driven him along even further. Like the same things that made him a successful athlete and student made him a successful addict.
posted by sweetkid at 6:02 PM on February 4, 2013 [2 favorites]


It's a hard thing to get my head around (no pun intended), this new world of nootropic and mood-control prescription drugs, let alone the massive problems with prescription opiates like oxy* in some places.

It's completely true that some people need them to function. It's completely true that some people will seek them out for recreational purposes. I think it's true, but perhaps debatable, that a lot of these drugs can be and sometimes are overprescribed. It's also true that there seems to be an indefensibly arbitrary line between what is sanctioned (and big business) and what is illegal (although recent changes with regards to marijuana seem to indicate that things may be changing), and a weird disconnect between potential harm and legal status.

It's all awfully messy, and it doesn't help when health care and insurance are broken, and massive pharmacetical companies have more power to direct the conversation than they should.

But to say 'I'm not going to give a shit about drug addicts' (as someone did in a now-deleted comment) doesn't seem like a helpful way to approach the issue. Almost everyone can become addicted to one thing or another -- including drugs allowed and even encouraged by society, like alcohol or caffeine or nicotine -- and some people are simply more susceptible to addiction than others, for any number of reasons.

When I was much younger, I enjoyed some illicit drugs (and still enjoy alcohol), including some that are considered to be very addictive indeed. I never developed dependancies, and for that I feel extremely lucky. I don't think it's because I'm better than anyone else -- I really don't know why I could just stop when I wanted to. I know that for most people, that's not an easy thing. I have (or had, because some died or disappeared) a lot of friends whose lives were ruined by cocaine, in particular, and even more whose lives were ruined by booze.

Difficult as it may be not to, looking at people who develop dependencies on chemicals -- whether they are prescribed and 'legal' or not -- as somehow unworthy just doesn't help. It can happen to every kind of person, good or bad, rich or poor, inside or outside the law's approval.

When the drug dealer and addiction-enabler is the medical establishment rather than the dodgy guy with the pet snake, it provokes a different kind of anger, and well it should.

It gets tricky when the drugs that are flooding into communities are prescribed by doctors, who we are brought up to trust. Even trickier when, in the case of Adderal and the like, the drugs are not all that much different than the amphetamines youngsters like me and others have abused for generations. Anybody else remember 'white cross' speed? Trickier still when those drugs aren't being prescribed and then resold to people seeking recreational pharmaceuticals, but are destroying the lives of the people they are actually prescribed to.

Then there's the problem of these things being (debatably) overprescribed, sometimes, one suspects (and reads), due to corruption and payoffs from pharma corporations. And the further problem of abuse and secondary markets making it harder for people who really do need them -- kids with actual ADHD or people who legitimately suffer chronic pain or other conditions.

And much as I think the more rational approach to marijuana recently (which is a whole other class of drug I know) is a step in the right direction, the nudge-nudge-wink-wink-get-a-scrip-so-you-can-get-a-dispensary-card situation that has gotten so much play in recent years in California especially in recent years creates an attitude, I think, that bleeds over into the use of much more dangerous drugs (like these amphetamines) for fun or for enhancing academic focus. When you're young (I remember, dimly) it's pretty damned hard to imagine street drugs doing you any serious harm, let alone drugs that other people are getting from their doctors. Let alone drugs some people are getting from their doctors by reciting symptoms they got from a forum thread telling them how to get a scrip for study drugs.

Which again makes it harder for people with legitimate need to get the treatment they require.

It's one hell of a mess. I've always been a knee-jerk 'legalize-and-tax-it-all' person, mostly because it is such a mess, but I'm not at all sure that would be a good approach either. I guess I'm glad that at my advanced age, my worst chemical habits are too much coffee, beer on Friday and the occasional cigarette.
posted by stavrosthewonderchicken at 6:06 PM on February 4, 2013 [8 favorites]


and then there is this:

for many years, talk therapy was the in thing. Then certified doctor/therapists discovered that insurance limited time of coverage because talk think not science. So many switched to dispensing meds, mixed with a little talk, and they got long time coverage and lots of repeat biz.

Clearly if a proper diagnosis is made, then meds will be useful...but then there is the ease on college campuses where this stuff is available.

I wonder about the ref to a nurse practitioner allowing drugs to be ordered. Is she qualified for this, really?
posted by Postroad at 6:06 PM on February 4, 2013 [2 favorites]


At the end of the day, this guy was an adult who was deceiving his doctors. The problem with generating too much outrage is that the war on sick people is already seriously affecting the quality of life of millions of people in this country.

And really, the problem isn't even the Adderall. Taken as prescribed, it's not at all likely to lead to anything more than some jitters. When you're taking three or four 60mg pills at a time, on the other hand, it is quite likely to do that. It sounds like the best and easiest solution would be to require doctors (or more likely their staff) use the system that appears to already be in place to track all prescriptions a particular individual has received recently to verify that they're not getting prescriptions from multiple doctors.

I also think that better educating patients on the effects of the drugs, and just as importantly, the withdrawal symptoms that will be experienced, would also help. The subject of the article probably wouldn't have killed himself had he gradually reduced his dose back to something normal rather than stopping cold turkey. I seriously doubt he was ever told what a bad idea it would be to do that, though.
posted by wierdo at 6:18 PM on February 4, 2013 [12 favorites]


If you are addicted to adderall, you are addicted to crystal meth -- concerta, cocaine.

No, that's really not how these things work.

Most people do not become addicted to ADHD medications. A small proportion of people do, and the effects can be severely harmful or even deadly. Similarly, most people do not develop Stevens-Johnson syndrome when they take ibuprofen. A small proportion of people do, and the effects can be severely harmful or even deadly.

Many common drugs have rare, severe side effects. They continue to be used because the overall benefit of their use outweighs their risk. Oftentimes, that's a decision that has to be made on a patient-by-patient basis.

I'm fairly appalled by the prescribing decisions of the doctors in this article, even apart from the Adderall. Giving Wellbutrin to a patient with psychotic symptoms is highly questionable. Giving Seroquel to help with sleep is a terrible (if exasperatingly common) practice. Giving an antipsychotic and a dopaminergic agent at the same time is just idiotic. It amazes me sometimes how little doctors seem to know about the medications they prescribe.
posted by dephlogisticated at 6:26 PM on February 4, 2013 [22 favorites]


I live in Virginia and have taken Concerta (controlled release) for the past eight years. I'm really, really surprised he and his doctors didn't get investigated by the state based on the prescription history detailed in the story. Did anyone else feel that there was some important information left out of this story?
posted by playertobenamedlater at 6:30 PM on February 4, 2013 [3 favorites]


At the end of the day, this guy was an adult who was deceiving his doctors. The problem with generating too much outrage is that the war on sick people is already seriously affecting the quality of life of millions of people in this country.

This. I may have been too harsh or flippant with my comments that got deleted earlier, but it's hard for me to contain my rage at this outrage. You combine the fact that it's really hard to think of a situation in which it's less devastating to have a felony drug charge with the war on sick people, and I really can't find much sympathy in my heart for some suave handsome dude who's good at manipulating doctors into feeding his addiction and winds up killing himself because of it.
posted by bookman117 at 6:31 PM on February 4, 2013


I was touched by the beginning of Richard's story because it might very well have happened to me. A therapist -- a good and well-meaning one -- suggested that I might have ADHD. This was after a childhood full of books and quiet, plus years of good grades. He suggested that I might never have been diagnosed because I was a girl, and I daydreamed and drew instead of acting out. I didn't buy it.

Luckily, I figured out what was troubling me at that time -- I had trouble concentrating on what I did because what I did was boring. At that time, I was drinking scads of caffeine, and I finally realized that I was drinking it not in response to sleepiness but in response to inattention. I was bored because of a mismatch -- life bored me. Because I did not have ADHD, I was able to adjust my attitude, and adjust my work, and things got tolerably better.

This is not to deny the existence of ADHD at all. It's just that I suspect that at some level, Richard's work was not for him anymore, and he didn't know how to handle the fact that he was tired of doing things. No one teaches young ambitious people like Richard that sometimes it is, in fact, okay not to be interested in things.

(On preview, I note that it is suggested that it is more virtuous not to care about what happened to Richard, because his family's story does not help enough people. Welp; can't speak to that.)
posted by Countess Elena at 6:38 PM on February 4, 2013 [8 favorites]


You combine the fact that it's really hard to think of a situation in which it's less devastating to have a felony drug charge with the war on sick people, and I really can't find much sympathy in my heart for some suave handsome dude who's good at manipulating doctors into feeding his addiction and winds up killing himself because of it.

Because he's addicted, that's why. Yes, he probably used his education and his med school plan to get what he wanted but that's just the tool used to feed his addiction. If he weren't suave and handsome, he would have been trying some other trick to survive as he understood it.

A couple of months ago, I had surgery requiring some serious oxy pain relief. I took it for three days, then realized I was reaching for it when I didn't need it. So I immediately tossed it. As someone with addictive characteristics, including booze, I was able to spot it before it hooked me. It is scary how this powerful stuff hooks people.

On the other hand, I'm completely opposed to the FDA plan to force people in pain to visit their doctors first and then go to the pharmacy to get a new prescription, every single time. That's putting bureaucracy over people.
posted by etaoin at 6:51 PM on February 4, 2013 [5 favorites]


I hate this article because I think it tends to reinforce common misperceptions and spread moral panic about a medication that has been extremely helpful to millions of people with ADHD.
posted by humanfont at 6:51 PM on February 4, 2013 [2 favorites]


Humanfont, just one view here, but I didn't come away from this article with a negative opinion of the drug. I thought it told us about addiction and a less than effective medical care system.
posted by etaoin at 6:58 PM on February 4, 2013 [6 favorites]


One of the problems with drugs like Adderol is that they make people feel good whether or not they are helping clinically. People then take the medication for the feeling rather than the effect.
posted by CheeseDigestsAll at 7:14 PM on February 4, 2013


Who told you Adderall makes you feel good, CheeseDigestsAll? I took it for years and it was more like having an angry voice in my head shouting at me. The voice was insistent enough to help my focus, but I didn't exactly feel great.
posted by DirtyOldTown at 7:18 PM on February 4, 2013 [3 favorites]


The problem with conflating the effectiveness of the drug as measured by improved performance with its efficacy as treatment for the underlying condition is not that it's pleasurable--it's what I like to call the Phantom principle -- "given enough thrust even a brick can fly."
posted by snuffleupagus at 7:27 PM on February 4, 2013 [2 favorites]


Who told you Adderall makes you feel good

Adderall without any doubt helps most people focus and generally elevates mood. The pharmacological basis for the mood elevation is well known and people have been taking speed and speed-like stimulants basically forever for just that reason. So, yeah, stimulants tend to make most people feel good and a lot of people end up taking them for that reason.

We don't have any problem saying that there are people in pain who really need hardcore pain meds while still recognizing that there is a problem with folks abusing oxycontin. But we seem to have trouble making that same judgment about other serious medications like Adderall. And it is serious, serious medication. There are people for whom Adderall or other ADHD drugs are a lifesaver. It's also true that a lot of people abuse stimulants because they make you feel good and help you focus. That's not in any way casting aspersions on folks who need it to get by.
posted by Justinian at 7:31 PM on February 4, 2013 [2 favorites]


(okay, not forever. But many many decades. Which is like forever! Right? They have been using stimulants basically forever, but not necessarily speed or speed-like ones.)
posted by Justinian at 7:33 PM on February 4, 2013


To elaborate a bit, I've never felt Dexedrine or the other meds I've taken have done anything to improve my ability to concentrate, so much as they've added an external force that makes me feel as though I must keep doing an activity even though my concentration has dissipated. It does absolutely nothing to improve my thinking or my conceptual organization. In fact, I think it may worsen it.

Again, the problem/point there from my perspective is that while whether or not it's pleasurable is variable from individual to individual (same as cocaine, which some people may enjoy and others may hate) the fact that it helps someone overcome focus and organizational problems should not be taken as evidence that they have ADD. Which is actually how it works in schools, which is where the huge spike in prescriptions has come from: schools and teachers offloading remedial work for struggling kids to medication. I caught the first wave in this set back the 90s, and it's only got worse since the move to standardized testing under NCLB and the reduction in services that states and cities can provide; playing into the efforts of pharma to encourage the use of these medications as a panacea for challenged administrators, teachers and parents.


I'm glad that ADD/ADHD is now recognized and that treatment is widely available, but it's gone from being underdiagnosed to hugely overdiagnosed in my view. That does a disservice to both people that really do have ADD/ADHD and those that don't.
posted by snuffleupagus at 7:43 PM on February 4, 2013 [2 favorites]


Pharma as the dopeman: While the gov't treats cocaine and crystal meth as narcotics, the drug companies add methyl groups to each and call them concerta and adderall. If you are addicted to adderall, you are addicted to crystal meth -- concerta, cocaine.

This is terrible. I don't think his parents really know what he was dealing with.


This is completely wrong. Methylphenidate and cocaine are completely different. Crystal meth is methamphetamine. IE, it is amphetamine WITH a methyl group. Adderall is amphetamine without it, and in a couple of different forms so it metabolizes at different rates.

And there is a difference between use and abuse. Methamphetamine is a perfectly acceptable drug, in the right dosage for the right reason. So it cocaine.
posted by gjc at 7:43 PM on February 4, 2013 [1 favorite]


I have had a similar experience to the subject of the article.

I was once a teenager with moderate depression who was tired of being inexplicably sad all the time and, with my parents help, decided to seek help. My parents found my therapist, who worked in conjunction with a Psychiatric Registered Nurse. I was not very forthcoming about the severity of my symptoms; on my first visit, I was told that if my therapist deemed me a danger to myself or others, I could be committed to a psychiatric hospital. On further visits, I had a discomfort and perhaps a dislike of my therapist. There was not a good personality fit. Did I know that you should "shop around" for therapists? Not in the least. Not until my first psychology classes in college. I thought as much consideration needed to be given to choosing a therapist as to choosing a general doctor. (Are they licensed? Do they take your insurance? Are they nearby?)

Probably less than a month after seeing the therapist once a week, they decided to administer me what I believe was the MMPI and a booklet that contained an assessment for ADD/ADHD. My parents were given a booklet that they answered about my symptoms, and in conjunction, a diagnosis was formed. My therapist told me the test showed I had ADD and spent a session explaining to me why I might not have realized it before. I told them that I wasn't having trouble in school because I couldn't concentrate, I was "having troubles in school" because I didn't care anymore. I told them I did not want help for ADD, I wanted my depression to go away. I was told stimulants would alleviate some of my depressive symptoms. I had mentioned to both the therapist and psych RN that both me and my family had addictive traits. I mentioned how I had spent most of the previous school year high on various substances, one in particular. I was asked by the therapist, "but could you stop taking that substance?" I replied yes. And the response was "well then you weren't addicted and you have nothing to worry about."

I did become addicted to the Adderall they eventually gave me. First it was Concerta; then when the Concerta wore off, it was Adderall XR; then when that lost its potency, it was Adderall IR after the XR subsided. I felt good for maybe the first time in my life and I, too, was given the spiel about Adderall having little to no adverse side effects. My young mind had no idea the stuff could really be bad for my health. I stopped sleeping. Often staying awake up to 48 hours. I was severely irritable. And eventually, psychotic. I took multiple doses in a 24 hour period to stay awake for school after only getting tired at 6 am. I honestly have no idea how much Adderall I probably had coursing through my body then. When I stopped taking the drugs cold turkey was when the psychosis began.

At my parents' alarm for my irrational thinking and behavior, I was put into a mental hospital. I spent a whole summer in and out a few different ones. It was a carousel of neuroleptic drugs and group work. In the hospital, I took anywhere from 3 to 5 pills at a time, usually twice a day. The rest of day was spent very hazily coloring or making cookies, talking about substance abuse, talking about family relationships, going to bed early. I was there so long and so often, one of the workers gave me well-intended advice that I should pretend I want to go back to my family (we had a strained relationship) if I ever wanted to get out of there. I don't believe my time in the mental hospital helped to do anything except at least wean me off the Adderall in a controlled environment. I am almost certain I have memory loss from the constant cocktails of psychotropic drugs forced upon me.

About 3 months after my stay in the hospital and after seeing a therapist and psychiatrist weekly in my hometown, I was completely weaned off all psychiatric drugs.

The experience has left me with little faith in the mental health care system. I honestly do not think my first therapist should still have a license. I do not think I was adequately warned about the effects of Adderall or prescribed it for a legitimate reason. I think mental health care should come with some kind of caveat emptor or, at least, a discussion from your primary care doctor or information from your health insurance agency or just somebody about what to expect from your mental health care provider. I fell under the trap too of believing I could trust in my doctor. With mental health care, perhaps due to the public's general unfamiliarity with it, it seems like that trust can be more easily taken advantage of and that mental health needs can more easily be misconstrued and/or misinterpreted.
posted by sevenofspades at 7:44 PM on February 4, 2013 [18 favorites]


Who told you Adderall makes you feel good, CheeseDigestsAll? I took it for years and it was more like having an angry voice in my head shouting at me.

I was diagnosed with ADD when I was in my early 20s, and had a similar experience with a prescribed stimulant, before dropping it because it made me angry all the time. I then, some years later, used stuff like speed and e recreationally, as well as adderal. I can tell you without doubt, that adderal in the right dosage is extremely similar in terms of the euphoria it produces to meth. A lot of it is just dosage and context though. If you're taking it to go party, then you're going to have a much different experience than if you take half a pill so you can get your house cleaned or whatever.

There is nothing magical about Adderal that makes it a good 'medicine' and crystal meth a bad 'drug'. They're extremely similar.
posted by empath at 7:48 PM on February 4, 2013 [2 favorites]


Which means that those of us with unmistakable ADD still need to think very carefully about a (potentially much shorter) lifetime of being on these drugs. It's not like the effects on your metabolism etc. disappear because you don't get obviously spun due to different neurochemistry. I, for instance, am already hypertensive by genetic predisposition....
posted by snuffleupagus at 7:57 PM on February 4, 2013


There is nothing magical about Adderal that makes it a good 'medicine' and crystal meth a bad 'drug'. They're extremely similar.

This exactly matches my experience. The difference is of course that people tend to take Adderall at known dosages of known purity under the supervision of a doctor. Theoretically. But that evil demon drug crystal meth just waiting to turn us all in to toothless meth zombies? Yeah, it's very very much similar to the pill little Bobby is taking every day. The magic is in the dosage.
posted by Justinian at 7:59 PM on February 4, 2013 [1 favorite]


For me, taking Adderall was like having a very loud voice in my head constantly going:

STOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUP

Etc.

Sincerely. That is as well as I can explain it. This was something I endured to improve upon the symptoms of my ADHD rather than something awesome I got to enjoy.
posted by DirtyOldTown at 8:02 PM on February 4, 2013 [4 favorites]


Did anyone else think this article was one-sided? Certainly Richard was mentally ill and had a drug problem, but I don't believe that Adderall is the whole story. The author (and just about everybody who was interviewed) seemed to assume that if it weren't for the drugs, Richard would have been just fine -- and that's not how I read it.

It sounds like he showed signs of serious mental illness (paranoia, delusions) before his drug abuse got way out of control, and he was never properly diagnosed or treated. We also don't really know what kind of relationship he had with his parents, except that they took a hostile/adversarial position on his decision to medicate from the very beginning. In fact, after reading it I felt like I didn't really know much about Richard at all -- his childhood? Did he date? Even the "lifelong friend" who was interviewed didn't sound that close to him, I thought. Also, it would have been helpful to hear from a former teacher or professor, since the article repeatedly portrays him as an ambitious student and that's presumably why he sought study drugs in the first place.

I realize the article was also making a broader point about how mismanaged and impersonal this country's health care system is, and how Adderall and other stimulants are widely abused. I'm in favor of journalism that promotes thoughtful and solution-oriented discussion about those problems -- but this article was a fear-mongering hit piece on drugs that legitimately help some people, and that bothered me.

I dunno. The Fees experienced something horrific and tragic, and I don't mean to minimize that. I just don't think tragedies like this have simple explanations.
posted by perryfugue at 8:03 PM on February 4, 2013 [19 favorites]


It's a hard thing to get my head around (no pun intended), this new world of nootropic and mood-control prescription drugs, let alone the massive problems with prescription opiates like oxy* in some places.

Welcome to the 1850s, dude.

This exactly matches my experience. The difference is of course that people tend to take Adderall at known dosages of known purity under the supervision of a doctor. Theoretically. But that evil demon drug crystal meth just waiting to turn us all in to toothless meth zombies? Yeah, it's very very much similar to the pill little Bobby is taking every day. The magic is in the dosage.

And in the delivery. If you're snorting or smoking Adderall, you're doing it wrong.
posted by Sys Rq at 8:07 PM on February 4, 2013


The NYT frames him as a really gifted student just because he aspired to attend med school but he seems to have been a mediocre student at best at a mediocre college, and he probably didn't have the study skills necessary to do well on the MCATs. Even with Adderall and drugs that enhanced his focus, he posted low scores on the exam.

He clearly had bigger issues that led to his abuse of Adderall. He sounds like he had rage/violence problems as well.

I know his parents are grieving, but placing the blame on the docs or Adderall is a bit much. There was clearly a lot wrong with the guy (he was violent and isolated himself and didn't reach out to anybody) and blaming the doctors would be like blaming the parents for raising a very skilled liar. There's no point.

What really jumped out at me is the way his parents tried to reach out to him continually and he just staved them off. No close friends, no one to confide in? Just people who say, "Oh, i played baseball with him, he was a good guy." That lack of a strong support network that validates who you are and who you are trying to be, even for mentally well people, is unhealthy.
posted by discopolo at 8:24 PM on February 4, 2013 [12 favorites]


I take a different prescription stimulant for a different reason. I was diagnosed with idiopathic daytime sleepiness almost a year ago. My doctor prescribed modafinil (nuvigil). It has been wonderful. That said, I have to jump through hoops to get it every month. It's not available as a generic so it's $500+ for my insurance company each time I get it filled. Before I could even get a prescription, I had to go through two sleep tests, one overnight and one daytime, for which I had to miss a day of work. I don't abuse it. I sincerely cannot stay awake for a whole day without napping in its absence, regardless of how much I slept the night before or how much coffee I drink. I don't know why but that's what my body is doing these days.

I don't really know what my point is except to say that some people need prescription stimulants and when taken appropriately, they can dramatically improve one's life.
posted by kat518 at 8:26 PM on February 4, 2013 [5 favorites]


This exactly matches my experience. The difference is of course that people tend to take Adderall at known dosages of known purity under the supervision of a doctor. Theoretically. But that evil demon drug crystal meth just waiting to turn us all in to toothless meth zombies? Yeah, it's very very much similar to the pill little Bobby is taking every day. The magic is in the dosage.

A dosage that is one or even two orders of magnitude greater than the ones used for legitimate medicine. Meth also (allegedly?) has a significantly different effect on serotonin than regular amphetamine.

Of course it's addictive. When you abuse it. Just like alcohol, caffeine, tobacco or even sugar.
posted by gjc at 8:28 PM on February 4, 2013


Welcome to the 1850s, dude.

That seems like a needless slap. I make no secret of the fact that I am an old fucker, and increasingly disgruntled with (some of) the ways society has been changing.
posted by stavrosthewonderchicken at 8:36 PM on February 4, 2013 [1 favorite]


Methamphetamine is not equivalent to amphetamine, which is not equivalent to methylphenidate. They all have similar pharmacological properties, with a good degree of overlap. But when it comes to clinical profile, it would be a mistake to overlook differences between drugs of the same class.

Someone upthread mentioned the one-methyl difference been Adderall (mixed amphetamine salts) and crystal meth (methamphetamine). An equivalent comparison could be made between codeine and morphine, where one methyl group is all that differentiates an ingredient in children's cough syrup from a powerful analgesic. Could someone abuse codeine, or even become addicted to it? Absolutely, but the risk is a great deal lower than for more potent drugs like morphine, which is why it can be purchased without a prescription in many countries.
posted by dephlogisticated at 8:45 PM on February 4, 2013 [6 favorites]


My doctor prescribed modafinil (nuvigil). It has been wonderful.

I tried that once, and my experience with it is that it was absolutely nothing like any other stimulant I've tried. No euphoria, no crash. My first impression of it was that it was near miraculous. Incredibly effective at increasing alertness with minimal chance of addiction. I have no idea what long term usage does to you though.
posted by empath at 8:51 PM on February 4, 2013


That seems like a needless slap. I make no secret of the fact that I am an old fucker, and increasingly disgruntled with (some of) the ways society has been changing.

No slap intended. It's just the facts. These drugs -- if not their current re-re-re-patented re-re-re-formulations -- date back over a hundred years. There have, quite simply, been no such changes in society. If anything, recent developments have only made those old-timey drugs harder to abuse.

You may revert to your original state of gruntledness.
posted by Sys Rq at 9:01 PM on February 4, 2013 [6 favorites]


Well, fair enough, but I was including in my woolgathering drugs like SSRIs and the like, which, if I'm not mistaken, are relatively new.
posted by stavrosthewonderchicken at 9:03 PM on February 4, 2013


Not everyone enjoys taking Adderall, as has been noted. By the time a friend's husband was finally diagnosed with ADD and prescribed Adderall, it really worked wonders to allow him to focus and organize his thoughts. He is also dyslexic and, in graduate school, was provided legally mandated assistance with lecture notes and time accommodations for exams. Once the degree was awarded, he chose to stop taking the Adderall, saying he hated the way it made him feel and now he will only goes back on it when things reach an impasse because of his inabilities to cope. He is a lovely man with many wonderful qualities but he has a real need for this medication even though he does not enjoy taking it at all. The problem has now become convincing him to take it.

Anecdata, of course, but, old codger that I am, I remember the pharmacological fashion in the fifties that produced the phenomena described in Valley of the Dolls. Dexadrine was available over the counter for a time in the fifties; it was thought a harmless appetite suppressant and women took in cities all over the country. Many, like me, found it as easy to get from their doctors as tranquilizers and sleeping pills which balanced things out nicely. I think the country went through a period when these medications were fashionable--overused and overprescribed, especially for women. It worked miracles. We stayed slim, we had energy and we could sleep at night and we weren't 'nervous.' Of course it couldn't last and we either stopped or addiction set in.

There has definitely been an uptick in recent years in the number of people, especially children, diagnosed with ADD and ADHD. Whether that is because it is now a fashionable diagnosis with its own fashionable pharmaceuticals or just a way of trying to cope with children being born into an ever more rapidly changing world, I cannot say. I wonder if the whole species could have developed this new disease virtually over a decade or two.

Therefore, I'd suggest that all these things may be happening: fashionable misdiagnoses, less careful diagnoses, scamming and doctor shopping by drug seekers, and patients with genuine ADD and ADHD who are being properly seen and properly prescribed drugs that make all the difference in their lives.

I can attest to the frustration and panic of a parent whose adult son's doctor will not recognize or acknowledge any responsibility for helping with the patient's addiction and reacts to the parent as if they are ignorant of the circumstances and simply anti medicine. I have fought that fight and I, too, have lost. In these situations, the parents suffer a much greater loss than the doctor does.
posted by Anitanola at 12:23 AM on February 5, 2013 [3 favorites]


It is my understanding and experience that in a therapeutic dose, Adderal generally only elevatesood over the short term. The improvement to executive function continues after the euphoria fades. The idea that it has lost its potency because people no longer experience the euphoria is a common feeling and often leads those who self medicate or who have doctors who don't know better to end up chasing higher and higher dosages which leads to bad things.
posted by humanfont at 4:42 AM on February 5, 2013 [1 favorite]


this reminds me of another scare piece New York Times has written concerning opiate medications. Yes these drugs can be addictive and yes people do them. In fact I know many people that taking the exact same steps that the man in the article had to receive these medications.
there is no question in my mind that these medications are over prescribed. As a grad student it's no secret that many people seek these medications during exam time.certainly these medications have their therapeutic qualities that help many many people but they're always be people will become addicted. Making it more difficult to obtain this medication will only place an undue burden on those who need the medication. Identify ths slippery slope of moving from dependence to addiction should be the obligation of the prescribing doctor.

Coincidentally I read this article on Sunday after taking 30 mg of Dexedrine obtained from a friend. While I've dabbled with amphetamines I understand the risks and rarely indulge for those reasons (plus I hate the crash). I must say my kitchen has never been cleaner, read two weeks worth of class material in advanced, outlined a memo and took care of a back log of equipment I've been meaning to fix. These drugs can be very useful tools but caution should be exercised.
posted by handbanana at 8:16 AM on February 5, 2013


It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall.

You know, instead of turning this into a giant debate about ADHD and medication for it, it seems to me that this right here is the problem. Prior issues with substance abuse and manic episodes are both indications that someone should not be receiving amphetamines unless there is a very good reason and they have proper supervision. Giving someone who has just gotten out of the hospital after a psychotic episode a 90 day supply is way past "not recommended". I would have no problem declaring this doctor's behavior negligent, especially since he was alerted to the issues by the parents.
posted by nTeleKy at 9:30 AM on February 5, 2013 [3 favorites]


I noticed later in the article that "He told Dr. Ellison that the pre-psychotic and metaphoric thinking back in March had receded, and that all that remained was his A.D.H.D. He said nothing of his visits to Dr. Parker, his recent prescriptions or his week in the psychiatric hospital." It also appears that after Dr. Ellison was informed of this, he did eventually switch the medication to Strattera. In any case, it's a tragic situation and I'm sorry that it ended the way it did.
posted by nTeleKy at 12:06 PM on February 5, 2013 [1 favorite]


I wonder about the ref to a nurse practitioner allowing drugs to be ordered. Is she qualified for this, really?

Briefly - yes. Nurse practitioners often have just as much school, if not more than doctors. Additionally, because of insurance policies have more time to spend with individual patients. Meaning that they are much more likely to get it right than a doctor. Is this true all the time? Obviously not. But distrusting a nurse practitioner because of the title is foolish. Additionally, in most states, Nurse practitioners have to practice under a doctor, who signs off on most things. So, you get two pairs of very educated eyes and brains for the price of one.
posted by stoneweaver at 1:21 PM on February 5, 2013 [1 favorite]


Classic drug panic story: blame the doctors, excuse the addict who lies, pretend that addicts can't be "nice people like us" or that they "look different" now. And pretend that doctors have some kind of magic, perfect lie detector that has evaded the rest of us (including the police and others who are supposedly expert but rarely perform much above chance) and blame them when they don't. Indeed, demand that doctors be kind and empathetic and trust their patients even though there are no measures of things like pain and ADHD which are not at least somewhat subjective— and then suddenly turn around and become the DEA and question everyone's pain and accounts of their experience.

As if this guy wasn't going to be able to get the drugs on the street if he wanted and as if he really believed "if it comes from a doctor, it has to be OK." Anyone heading for medical school with any chance at all of getting in could not have genuinely thought something like that— and I'm sure he actually didn't. The packaging of the drug has warnings about addiction and psychosis; anyone who knows anything about drugs knows that they have risks as well as benefits, even when they are correctly prescribed.

The idea that medical = safe was his rationalization and for the reporter to take that completely at face value means he really doesn't know much about addiction. Adderall is amphetamine; you can get prescribed methamphetamine (DesOxyn) for ADHD as well. There's really very little difference— what matters is dosing and pattern of dosing and we've known that "speed kills" since the 30s, not just the 60s.

The problem here is that we can't seem to accept that life has risks and that we can't always be protected from them, especially if we're not going to be honest with health care providers. If we want to adequately treat pain and ADHD, there are going to be some addicts who are going to get over. That is not the doctors' fault in most cases (though in this one, there seem to have been some really strange mistakes)— and frankly, I think it's unfair to put people with medical conditions through the wringer in an attempt to kept addicts from drugs.
posted by Maias at 6:56 PM on February 5, 2013 [2 favorites]


For me, taking Adderall was like having a very loud voice in my head constantly going:

STOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUPSTOPFUCKINGUP

Etc.


Well, Jesus, am I glad I never tried Adderall. I was born with one of those.
posted by Countess Elena at 7:25 PM on February 5, 2013 [1 favorite]


Nurse practitioners often have just as much school, if not more than doctors. Additionally, because of insurance policies have more time to spend with individual patients. Meaning that they are much more likely to get it right than a doctor. Is this true all the time? Obviously not. But distrusting a nurse practitioner because of the title is foolish. Additionally, in most states, Nurse practitioners have to practice under a doctor, who signs off on most things. So, you get two pairs of very educated eyes and brains for the price of one.


This is probably the most egregious example of NP trolling I have seen thus far on the internet, and there's been quite a bit. I was willing to give you the benefit of the doubt until the very last sentence, which exudes pure ignorance of such magnitude that I realized it would literally be impossible for someone to really believe this.

Nurse Practitioners: Cheaper than doctors, even though they will happily spend all day talking to you! More empathetic AND more knowledgeable! But without all that wasteful medical training, we all know residency is just a series of lectures on hedge fund investing and the proper art and care of your BMW anyway.

In response to your blanket statement I could just as easily state that in my experience the Modern Nurse Practitioner (tm) instills the relevant medical training via apparent osmosis; an online masters degree they chip away at on weekends or during a third shift, paging me when Epocrates on their iphone isn't clear enough while they try to figure out the easiest way to end up practicing dermatology independently and billing at doctors rates in a cash only practice.

But the reality is that the majority of professionals (whatever the field) are only as good as the lowest bar of their training, and that bar is currently lower, not higher, for a nurse practitioner than it is for a doctor.

Two sets of eyes for the price of one, ludicrous.
posted by hobo gitano de queretaro at 7:27 PM on February 5, 2013 [2 favorites]


Come on, don't be so coy. Tell us what you really feel. Why not see if you can work a few more insults in there, too.
posted by stavrosthewonderchicken at 8:07 PM on February 5, 2013


Nurse practitioners often have just as much school, if not more than doctors.

Not true. I like NPs as well for general care. I like doctors too. Nursing and the masters program necessary to become an NP are shorter. Yale's program only requires the GRE.

I'm not saying it isn't arduous, and there are talented NPs who are way better at talking to and providing care for patients, but what you are saying really isn't true.

And hobo, you're being rude and insulting. Nursing and medical school are different. A nursing school can turn out a great NP. A PA program can turn out a great PA. A medical school may turn out a lousy doctor who doesn't keep up on new information and sticks to whatever he learned back when he was a med student or the last journal he read or maybe just listens to the best looking pharm sales rep.

It's a really dumb thing to argue about, especially if you aren't a healthcare provider who hasn't gone to either kind of school.
posted by discopolo at 8:11 PM on February 5, 2013


It's not dumb at all... because as you can see above by the comment that set me off, there is a real movement afoot to cast Nurse Practitioners as doctors. There are even a small evangelical minority that continue to insist that NPs are better than doctors.

I know this because I have met over a dozen such individuals who also insist on being called doctor. I'm not defending doctors at all, let me be clear. We have more than enough horrific skeletons in our closet for me to pretend otherwise.

My point is this is actually directly harmful, and the medical field in the United States is already way too screwed up and profit driven without throwing in (more) people who believe they have the training when they do not. I think that most doctors (I lied, I really mean their patients) would substantially benefit from some clear administrative oversight and targeted education.

If you really think that NPs are uniformly going to really be cheaper and better than doctors, you're crazy. That's not how the world works. Note that I'm not saying that a NP cannot be better than a doctor, that is certainly very true at times.

This has been tested repeatedly. This is why there are a clear series of professional level examinations and bureaucracy in order to become an independent practitioner (doctor). The easiest of these exams, United States Medical Licensing Exam Step III, a multiple choice, clinically based diagnostic computer exam, was adjusted downwards in difficulty given to an above average crew of PhD level NPs with decades of nursing experience from Columbia, and around 40% of the nurses was able to pass, even when given extensive coaching and multiple tries.

The pass rate for MDs and DOs of all stripes, international and otherwise, is like 98%.

That's just one example. There's a clear difference. All the other studies attempting to show otherwise are commissioned by the nursing or insurance lobby, and are hilariously full of egregious flaws.

Anyway, if they were really better than doctors they wouldn't insist that patients and staff call them doctor.
posted by hobo gitano de queretaro at 1:06 PM on February 7, 2013


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