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Two-speed America
July 3, 2014 3:49 AM   Subscribe

How much separates ADHD drugs from street meth? Not much. And where is it all going? "Aside from some foul cutting material, Winnebago methamphetamine and pharmaceutical amphetamine are kissing chemical cousins. The difference between them boils down to one methyl-group molecule that lets crank race a little faster across the blood-brain barrier and kick just a little harder. After that, meth breaks down fast into good old dextroamphetamine, the dominant salt in America’s leading ADHD drug and cram-study aid, Adderall."
posted by imperium (99 comments total) 24 users marked this as a favorite

 
I'm always glad to see articles breaking down the deep hypocrisy and fact-blindness on the war on drugs and how it intersects with the wars on poor people and black people.

That said, the bit quoted here is a kind of anti-scientific rhetorical scare tactic that drives me crazy. That little molecular difference may be small, but it matters a great deal, and brushing it aside as incidental isn't helpful to advancing rational conversation.
posted by rosa at 4:24 AM on July 3 [42 favorites]


Drug X, taken orally as directed, is not equivalent in abuse potential or pharmacological effects to Drug X insufflated, smoked as freebase, or (god forbid) mainlined. It turns out that with drugs of abuse, the faster the onset, the more addictive the drug becomes. Very few people who take Adderall as prescribed develop an addiction. Likewise, very few people who take oral narcotic painkillers as prescribed develop an addiction. Addiction, when it occurs, tends to happen to people that use the drug more often than prescribed or who utilize non-oral methods of administration. In what I'm sure must be a sheer inexplicable coincidence, this also tends to be the same cohort of people that seek out such drugs for recreational (as opposed to medicinal) purposes.

Generic Adderall is dirt cheap and has been for ages. No one's making much money off it. There is no Big Pharma conspiracy.

What there is, arguably, is a diseased culture. A culture in which focus and productivity are so fetishized that your average human attention span is no longer sufficient. A culture in which a significant proportion of the working (or academic) population requires psychoactive drugs in order to meet baseline expectations.
posted by dephlogisticated at 4:27 AM on July 3 [55 favorites]


It's Different for Girls with ADHD
posted by Artw at 4:28 AM on July 3 [21 favorites]


Aha, I read that differently - the specific chemical difference is set out, and the author also goes on to describe the subtle differences in effect from personal experience.
posted by imperium at 4:28 AM on July 3


I would encourage other readers of the article to spend a few moments on the comment section--I think many of them capture the problems with this article--glib, sensationalistic, bad analogies, bad science and as 'rosa" just said" That little molecular difference may be small, but it matters a great deal, and brushing it aside as incidental isn't helpful to advancing rational conversation.
posted by rmhsinc at 4:29 AM on July 3 [3 favorites]


“given access to enough amphetamine, any rat, monkey, or man would eventually self-destruct.”

Except that's not necessarily the case?
posted by oceanjesse at 4:33 AM on July 3 [4 favorites]


Articles about ADHD drugs are fine talking about success, work, competition, and advancement, but try finding one that calls the drug by its name: Speed.
...
There is a reason front groups like CHADD and ADDA focus on “the science of ADHD,” which is not hard science, and ignore the science of the drugs used to treat it, which is hard science.
...
A cheap and limitless supply of pharma-grade amphetamine, signed off by a friendly medical professional, struck me as an incredibly unwise pursuit. That’s how you become a heavy or daily user.
Hyperbolic tendentious nonsense by someone who has no idea what ADHD is or how "speed" affects people who have it. There are arguments to be made about the hypocrisy of the drug war and the evils of the pharmaceutical industry, and they've been made countless times by people who know what they're talking about. This article adds nothing.
posted by A Thousand Baited Hooks at 4:38 AM on July 3 [23 favorites]


Hyperbolic tendentious nonsense by someone who has no idea what ADHD is or how "speed" affects people who have it.

I've been diagnosed with ADHD, have been prescribed ADHD meds, as well as recreationally used meth, adderal and ritalin. I'll be goddamned if i could tell you the difference.

AFAIK, a low to moderate amount of any stimulant has the same effect on everyone. You're going to be more attentive, more alert, more focused, and perhaps a bit more talkative.

The difference with meth is primarily that it's rather trivial to take a recreational dose that will have you bouncing off the walls for 8 hours (or 8 weeks.).

Don't kid yourself, if you're taking ADD meds, you're using speed. Probably using it responsibly, but you're still taking speed. There's nothing magical about your brain that makes it affect you differently from everyone else.
posted by empath at 4:54 AM on July 3 [16 favorites]


As someone who finally sought some answers about lifelong attention issues at age 30, I was sort of relieved to receive an ADHD diagnosis, but also afraid of the rx solution I was offered. My experience with street drugs began and ended with pot-smoking a handful of times in my early 20's, which I could never get into. But wasn't Adderall basically meth? Would I become an addict? Would I simply need ever increasing dosages my whole life?? I was seriously concerned.

I was surprised to find the theraputic dose of my generic Adderall resembled something less like a desperate addict's high and more like... just the gentle evaporation of the fog I normally lived with. It astonishes me to hear that people can go through actual withdrawal of Adderall, or that people like "Lily" are instructed by their physician to avoid the danger of abruptly stopping treatment. Maybe the author left out more information about that particular case but... Adderall isn't like SSRI's. The clearance time for a dose of the non-extended variety is 4 hours. People who take amphetamine salts as an rx do stop treatment -- on a nightly basis. I have never detected a discernible withdrawal symptom from forgetting to take a morning dose. (Coffee is another story.)

My experience is may be as much anecdote as Zaitchik's, but in my opinion it seems like a startling lack of self-awareness for the author to suggest Breaking Bad as a "compelling one-sided cartoon" and a "modern day Reefer Madness," because this is easily the most Reefer Madnessy article on prescription amphetamines I've ever encountered.
posted by hegemone at 5:03 AM on July 3 [27 favorites]


There are not only articles to be written about the troubling aspects of overprescribing Ritalin and Adderall, but I believe that some have already been written. They're not the ones that begin with comparing Breaking Bad to Reefer Madness, FFS.
posted by Halloween Jack at 5:08 AM on July 3 [2 favorites]


What there is, arguably, is a diseased culture. A culture in which focus and productivity are so fetishized that your average human attention span is no longer sufficient. A culture in which a significant proportion of the working (or academic) population requires psychoactive drugs in order to meet baseline expectations.

I know you mean no harm at all, but ADD/ADHD, when it is severe enough to be diagnosed and treated with medication, is more than simply an issue of having a socially unacceptable attention span.

Don't kid yourself, if you're taking ADD meds, you're using speed. Probably using it responsibly, but you're still taking speed. There's nothing magical about your brain that makes it affect you differently from everyone else.


It says AMPHETIMINE SALTS/ AMPHETIMINE AND DEXTROAMPHETIMINE right on the bottle, in ALL CAPS. I don't imagine that there are too many people who are in denial about what it is they are taking.
posted by louche mustachio at 5:10 AM on July 3 [23 favorites]


AFAIK, a low to moderate amount of any stimulant has the same effect on everyone. You're going to be more attentive, more alert, more focused, and perhaps a bit more talkative.

If that is all it did for you, I suggest that your diagnosis may have been incorrect. Or maybe it just didn't work for you. Not every drug works the same way for everyone.

Don't kid yourself, if you're taking ADD meds, you're using speed. Probably using it responsibly, but you're still taking speed.

Oh, I have no problem at all with the idea of taking speed. I just found Zaitchik's obsessive focus on convincing people that amphetamines == speed to be a bit strange.
posted by A Thousand Baited Hooks at 5:10 AM on July 3


I've been diagnosed with ADHD, have been prescribed ADHD meds, as well as recreationally used meth, adderal and ritalin. I'll be goddamned if i could tell you the difference.

You mmmmay need to revisit the diagnosis or prescription. With ADHD, the medicine makes you calm and capable of focus. Without ADHD, or with a bad medicine fit, you're getting a powerful stimulant, with all of the "fun" side-effects.

I had a shrink who asked me about my caffeine habit (enough Diet Mtn. Dew every morning to kill a small dairy herd through convulsive heart palpitations), and then asked me how it made me feel - "Relaxed and ready" was my answer. "Not revved up and full of energy?" she asked. "Not particularly, more comfortable and settled," I replied.

And then she sent me for the tests, and lo, ADHD.

Adderall made me twitchy and uncomfortable - revved up and full of energy, which was kind of a bad thing as it made my focus issues worse. Wellbutrin worked muuuuuch better for me, giving the calming and centering I needed without the buzz. I know people who's experience with the two medicines is reversed, so mileage does indeed vary.
posted by Slap*Happy at 5:17 AM on July 3 [5 favorites]


We've had this exact conversation a bunch of times before:

"ADDERRALL R SPEED! IT MAKE U CRANK UP LIKE METH HEAD!"

–"That's actually not my experience. In fact it makes me calmer and I find I can -"

"UR DELUDING URSELF!"

– "Well, I and many other people with formal diagnoses report that the small doses we take –"

"DELUDING URSELF!"
posted by Joe in Australia at 5:23 AM on July 3 [44 favorites]


Oh my God this article is so terrible I can't even get angry.


BIG PHARMA HAS YOU ALL HOOKED ON THE SPEED!



It's official. Any article that refers to the pharmaceutical industry as "PHARMA!" will be dismissed as total bullshit and will have to work very hard to prove otherwise.
posted by louche mustachio at 5:24 AM on July 3 [8 favorites]


With ADHD, the medicine makes you calm and capable of focus. Without ADHD, or with a bad medicine fit, you're getting a powerful stimulant, with all of the "fun" side-effects.

Yes, absolutely this. The effect I get from generic Adderal is alertness and attentiveness. After I got my first script filled, my psych said I might also note a very subtle sense of well-being, which I did.

When he was in high school, my younger brother was prescribed same for what his doctor thought might have been narcolepsy or chronic sleep disorder (I'm fuzzy on the details, but it was not for anything like ADHD). He said the drug made him feel on edge and kind of angry all the time; he found that unpleasant and asked to be taken off the rx. This was probably for the best in his case.
posted by hegemone at 5:31 AM on July 3


Although I am apparently some sort of big pharma tool all hopped up on the goofballs, so there you go.



DELUDING URSELF..... ....~(◎●◎~)
posted by louche mustachio at 5:32 AM on July 3 [18 favorites]


But it’s been a long time since I bought the stuff [meth/adderall]. I now stick to the weak classical highs of coffee and tea, which can honestly and without obfuscation be described as harmless stimulants.
I dunno. Coffee often gives me the jitters something fierce, and I can hardly think in the morning anymore without sipping the first half of a cup of coffee, weekday or not. Still, I'm not on track to quitting anytime soon. On the other hand, adderall has helped me figure out some important parts of myself, get important life tasks done, and I was able to put it down when I felt done with it.

Are amphetamines over-prescribed in society? Probably. Is that bad for society? Also probably. Should we completely ban adderall as a tool for helping people? In my opinion, no.
posted by Phredward at 5:42 AM on July 3 [2 favorites]


The difference between them boils down to one methyl-group molecule that lets crank race a little faster across the blood-brain barrier and kick just a little harder.

But, no. The article starts out by mentioning Vyvanse, which is designed to metabolize slowly and thus be harder to abuse. It's not just a little slower than crank.
posted by pajamazon at 5:44 AM on July 3 [3 favorites]


I need to reread the article. My first impression was less, "Pharma is having a go at you all!" and more, "All of policy is bullshit from a scientific standpoint and historically we tend to overreact when Jon and Jane Q Public finally make the connection".

The science was rather wonky. I don't think that fully detracts from the line of thought that having a dangerous in the long term, illegal, and expensive version and a mostly safe in the long term, cheap, but behind an initial paywall/network-wall, legal version with similar effects on the brain makes any goddamn sense.
posted by Slackermagee at 5:53 AM on July 3


I'm just a little baffled why an article about stimulants is illustrated with a photograph of blue capsules labeled RX692. That's clindamycin. It's an antibiotic.
posted by Sys Rq at 5:55 AM on July 3 [38 favorites]


Google image search for the loss.
posted by Slackermagee at 5:57 AM on July 3 [4 favorites]


Don't kid yourself, if you're taking ADD meds, you're using speed. Probably using it responsibly, but you're still taking speed. There's nothing magical about your brain that makes it affect you differently from everyone else.
I agree that there's nothing magical about my brain, except that my brain seems to have a really hard time remembering to pay the phone bill. Even on Adderall, it's a challenge to keep my shit together: I've had both my phone and my electricity disconnected in the past year, even though I had plenty of money in the bank to pay the bills. But I am no longer routinely late to work because I can't find my keys. My apartment is clean enough that I am not embarrassed to have people over. I have kept a job that involves some organization and paperwork, and I even managed to get a promotion. Adderall allows me to be a reasonably functional adult, and if the price of that is admitting that I'm on speed, then fine. I take speed. I used to self-medicate with caffeine, which seems to be less of a scary, scary word, but it was a lot harder to get the dosage consistently right.

It's Different for Girls with ADHD
That is a scarily apt description of my life.
posted by ArbitraryAndCapricious at 5:59 AM on July 3 [15 favorites]


I'm just a little baffled why an article about stimulants is illustrated with a photograph of blue capsules labeled RX692. That's clindamycin. It's an antibiotic.

I'll simply chalk that error up to a minor deficit of attention. I wonder if there is a medication out there for that.
posted by chambers at 6:02 AM on July 3 [5 favorites]


Oh my God this article is so terrible I can't even get angry.

Haha, I was telling pretty much the same thing to a friend of mine while reading it. At this point I am contemplating writing an ADHD article generator where you can just click together what you want from the usual bad tropes in these articles, press "Generate" and presto, six paragraphs ready to publish.
posted by KTamas at 6:04 AM on July 3 [2 favorites]


Her hard sell to women, filled with references to Body Mass Index and the stresses of “keeping house,” is a throwback to the successful midcentury business strategy of the legal speed cartels: market to women by exploiting their insecurities about weight, productivity, and positivity

I'm not going to touch the BMI thing because everything to do with women and weight is way way too entrenched in wider issues than this article could hope to address.

But it's unfortunate (yet typical) that Zaitchik tries to call out some retro sexism without noticing the sexism of his own remarks. I don't think it's great that so many women end up having to default to the SAHM thing simply because the U.S. lacks a variety of really important parental support systems, but that's how it is. The chaos, disorder, and questions of ones own basic competence that can result from undiagnosed ADHD in women raising kids at home are no less deserving of treatment than the same problems of people who get paychecks for their labor. It is possible to recognize that Patricia Quinn is sales person, and to appreciate that her rhetoric acknowledges the issue rather than dismisses or minimizes it as merely the "stresses of 'keeping house'".

But the author is not big on nuance at any point in the article so this is probably too much to expect.

Quinn’s slide show also fails to mention that speed once provided researchers with their best experimental simulation of schizophrenia. During the 1960s, researchers concluded that habitual amphetamine use produced a more accurate “model psychosis” than LSD.


ughghghghgh seriously just... fuck you, guy
posted by hegemone at 6:06 AM on July 3 [3 favorites]


This article actually makes me suspect a last minute high dose amphetamine binge to meet a deadline was involved, the more I think of it.
posted by oceanjesse at 6:17 AM on July 3 [5 favorites]


I feel like I carry around this exact contradiction around pretty much every day. On the one hand I found that lack of focus resulted in anhedonia and lethargy that could last for weeks and on the other hand I now take Methylphenidate every day.

Yes, the distinction between legal and illegal drugs is mainly false. Yes, there are people who stand to gain from the widespread prescription of these drugs.

It's already been addressed but but the rhetoric here is pretty alarmist.

Look. I don't know if I have ADHD, or if it's real. I know that the pills I take help. Is it placebo? Maybe, but I'll take a placebo that's done for my moods and ability to complete basic tasks what these meds have.

Guess I'm just saying that maybe we should give each other some credit. Most people are probably aware on some level the contradictions they live. And everyone lives contradictions.
posted by angusiguess at 6:21 AM on July 3 [4 favorites]


Best of the web.
posted by spock at 6:30 AM on July 3 [1 favorite]


With ADHD, the medicine makes you calm and capable of focus.

Believe it or not, a low dose of any amphetamine makes everyone calm and capable of focus. Speed doesn't make people into a tweaked out nightmare unless they take 'recreational' doses, or if they snort it or smoke it, etc.
posted by empath at 6:38 AM on July 3 [1 favorite]


You could just be a reverse-responder, like me. Anything remotely speed-ish puts me right to sleep.
posted by PuppyCat at 7:02 AM on July 3


Aside from some kindling, raging urban fires and your household oven are kissing pyrotechnical cousins. The difference between them boils down to just a flimsy steel box that keeps the fire contained and away from other flammable materials within your house. Without that flimsy box, the "useful" hearthfire quickly grows into a good old raging inferno capable of wantonly destroying lives and property.
posted by griphus at 7:02 AM on July 3 [28 favorites]


Oh good, yet another article to demonize and further alienate those with ADHD who are able to live much better lives with the meds they have been prescribed.

It's only one part of the treatment, but without treatment, I'd still be out of control, likely unemployed, and definitely leaving a trail of emotional destruction, and wondering why things were going shitty the whole time.

Yes, it is a DRUG. So is caffeine, so is alcohol, so are so many other substances that we consume daily. And like many, it has the potential to do bad things when you take too much of it. I am quite aware of what I am taking. In fact, meth is prescribed as an ADHD med for some conditions - generally, as a last resort, but with good results.

The problem is that you never see good articles about how someones life got under control in a positive, not-overacheiving way due to a drug. ADHD meds seem to be a particular favorite for these scare article, and this one seems to be particularly egregious.

I can't help but feel like this is someones way of generating controversy for clickthroughs and revenue. Basically, some assholes are getting paid with a side effect of polarizing people even more over this issue. The long term effects of that polarization can't be ignored - I am being treated more and more like a criminal when I get my prescription, and I feel a need to hide how I live from more and more people.
posted by MysticMCJ at 7:04 AM on July 3 [8 favorites]


There's nothing magical about your brain that makes it affect you differently from everyone else.

This seems to be coming from an perspective that sees anyone who reports positive results as either lying to get a prescription for speed or deluded by the media and under the control of a dangerous drug, and just thinks their lives have improved from it.

The stuff works for me and has improved my life, and they'll just have to take my word on that. Though I understand the concern that one can be prescribed it just by being able to understand what the 'correct' responses are when being diagnosed.
posted by chambers at 7:08 AM on July 3 [5 favorites]


The problem is that you never see good articles about how someones life got under control in a positive, not-overacheiving way due to a drug.

Indeed, though articles like "Man recently prescribed anti-anexiety medication goes out to a party where he knows almost no one and has a grand time and made many new friends" or "Ritalin prescription saves man's job by allowing him to prevent a multimillion dollar company's network from collapsing" probably don't have the same page view potential.

Though you could add "Pharma critics HATE HIM" and get a few people these days.
posted by chambers at 7:23 AM on July 3 [3 favorites]


empath: "AFAIK, a low to moderate amount of any stimulant has the same effect on everyone. You're going to be more attentive, more alert, more focused, and perhaps a bit more talkative. "

I think my body has a hard time handling loads of stimulants much harsher than caffeine. When I took Ephedrine in my youth, I had the euphoric tingles, but always lied down. Not sure if, at that time, it was tiredness/fatigue or not.

But then when I took Methylphenidate (Ritalin) and Euphora when I was older, I definitely just got tired, not awake, not alert, and I did the proper "test a small amount first then slowly adjust over time" one should always do when trying a new drug. Perhaps my body was so sensitive that the dose I needed was even smaller than a low RX amount of Ritalin and I didn't start low enough, I dunno.

Does anybody else seem to have this issue? It's a shame, because I honestly would like to use certain chemicals in such a productive manner as needed, though I suppose I can see how that might lead to it being a crutch for me. Ugh.
posted by symbioid at 7:31 AM on July 3 [2 favorites]


YOU WON'T BELIEVE WHAT THIS WOMAN SAW AFTER TAKING "LEGAL SPEED"
.
.
.
.
.
.
.
.






WOMAN CAN ACTUALLY SEE FLOOR OF ROOM

______________"IT'S HARDWOOD!"__________________
posted by louche mustachio at 7:32 AM on July 3 [25 favorites]


My comment regarding There's nothing magical about your brain that makes it affect you differently from everyone else was posted thinking that line was in the article, and not a comment here.

In the context of which it was posted, it makes more sense, though I would argue there is at least some variation in response to ADD meds, and there are a few examples in this thread. As to how I got them mixed up, it is probably because I have taken my ADD meds yet this morning.
posted by chambers at 7:39 AM on July 3


I agree that there's nothing magical about my brain, except that my brain seems to have a really hard time remembering to pay the phone bill. Even on Adderall, it's a challenge to keep my shit together: I've had both my phone and my electricity disconnected in the past year, even though I had plenty of money in the bank to pay the bills. But I am no longer routinely late to work because I can't find my keys. My apartment is clean enough that I am not embarrassed to have people over. I have kept a job that involves some organization and paperwork, and I even managed to get a promotion. Adderall allows me to be a reasonably functional adult, and if the price of that is admitting that I'm on speed, then fine. I take speed.

I had a comment all typed out on my iPhone that basically said this but then I got distracted on the walk between the parking garage and my office and lost it.

The comment... not my phone.
posted by elsietheeel at 7:40 AM on July 3 [3 favorites]


Adderall helps me immensely. I can focus, stop procrastinating, actually finish tasks for a change. Gosh, lock me up. Obviously I am a danger to society.

Seriously, though, how much meth do recreational users take? Are the dosages really comparable at all to typical pharmaceutical prescriptions of Adderall?
posted by misha at 7:43 AM on July 3 [4 favorites]


Empath, YES!!! All the stimulants I've ever taken make me sleepy. Especially Ritalin, Adderall, Concerta. I've wondered if I should just try a smaller dose but I haven't tried talking to the doctor about it. I was diagnosed with ADHD in college many years ago, and my nine year-old daughter has a positive diagnosis as well (there's a genetic component). I am looking into supplements because neither of us respond well to the medications for it. DMAE, Alpha GPC, and omega-3's are strongly recommended for improved functioning.
posted by PuppyCat at 7:44 AM on July 3


There's nothing magical about your brain that makes it affect you differently from everyone else

Well I did gain weight after I started taking it.


That's different from everyone else.


And I guess kind of magical, but it's more of a dark, evil magic.
posted by louche mustachio at 7:45 AM on July 3


For what it's worth, a similar article could be written about morphine and it's acetylated sibling, heroin.

Another facet of all the hand-wringing about meth that amuses me is the oft repeated declaration that it is easily made from common household chemicals, but when an actual lab is found it's treated like a superfund site with the full hazmat team in action. I will concede that common household chemicals can be a lot more dangerous than people realize, though.
posted by TedW at 7:46 AM on July 3 [1 favorite]


Heh... Man narrowly avoids fucking up own life, those around him, with THIS ONE WEIRD TRICK.
posted by MysticMCJ at 7:54 AM on July 3 [3 favorites]


Brought to you by Methafilter.
posted by homerica at 7:56 AM on July 3 [2 favorites]


Methowie!
posted by symbioid at 8:03 AM on July 3 [2 favorites]


Artw: "It's Different for Girls with ADHD"

It doesn't sound different at all. It just sounds like ADHD-Inattentive, which has always been the bastard stepchild of the more visible/commonly known version of ADHD.
posted by barnacles at 8:30 AM on July 3 [3 favorites]


Seriously, though, how much meth do recreational users take?

Literally as much as possible.
posted by elizardbits at 8:31 AM on July 3 [6 favorites]


all of it all at once
posted by elizardbits at 8:31 AM on July 3 [4 favorites]


I'm always kind of amused by articles like this, because I once had to use Adderall for a few months because every form of generic Ritalin was unavailable. And I *hated* it, because I could feel the stimulant effects and it gave me that nasty coffee hangover feeling. As soon as 90 days were up I got a refill with my correct medication and still have a partial bottle of Adderall in a drawer.

People with ADHD don't take these things to stay awake or feel more alert; they take them so that they can concentrate and not flake -- I have managed to stay at the same company for a record length of time since I went on Ritalin.
posted by tavella at 8:34 AM on July 3 [1 favorite]


For me, Adderall instant release (sometimes in helpful sugary chewable tablets) is so, so different in sensation from the Adderall XR. The regular release version is like a triple espresso on an empty stomach after a night of drinking - jitters, wild-eyed twitchiness, everything. The XR is like "oh i guess this is how normal people feel all day, neato" plus an added ability to actually fall asleep at night because your mind isn't racing along wildly with random blurts of idiocy.
posted by elizardbits at 8:38 AM on July 3 [5 favorites]


> People with ADHD don't take these things to stay awake or feel more alert; they take them so that they can concentrate and not flake -- I have managed to stay at the same company for a record length of time since I went on Ritalin.

Exactly. I'm sure many could say this about relationships as well as the work place... I can't imagine how frustrating it is to be on the opposite side of me when I'm off meds. I'm literally thinking to myself out loud YOU MUST PAY ATTENTION AND RETAIN THIS and things just fall through while I try to avoid the earworm stuck in my head and everything else happening in the background. It's certainly for no lack of trying.... If you are familiar with photography, you've no doubt seen what selective focus can do to isolate a subject. It's like I'm shooting everything at F/100, everything is equally in focus, and sometimes that works, sometimes it doesn't.

Off meds, and prior to meds, I've had to literally take notes during personal conversations. You can imagine how well that can go over. "Can you put the dream-building on hold just a sec? I need to write this down."

I will say that having felt the effects of the wrong medications or too much of them is something that I do notice, and I find unpleasant, to say the least.

On preview: elizardbits nailed it for me. The extended release forms have been the secret for me, instant release was usually giving me horrible headaches on top of everything else mentioned. Vyvanse has been the great normalizer for me, for whatever reason that works best with my body chemistry. I won't say that's true for everyone, I know people who do great with instant release ritalin.

I really wish that we had the science behind the brain enough that we could actually point to repeatable and irrefutable tests that would be able to state "yes, there's a condition here, and this is the best way to prove it." Unfortunately, until we are there, this really is a "best educated guess and check" scenario - as is much of mental health. What manifests one way for a person may manifest entirely differently for another, just like how one med may be good for a person whereas another may not.
posted by MysticMCJ at 8:48 AM on July 3 [1 favorite]


It's the opposite for me -- the ER versions seem to accumulate so I'll have that post-coffee feeling in the late afternoon, though they've worked okay when I took half-instant, half-ER. The instant release seem more invisible to me, but that's the joy of different people and different formulations.
posted by tavella at 9:09 AM on July 3


Supposedly 80% of those diagnosed with ADD experience the paradoxical effect of stimulants making them sleepier. For me, I know I have ADD (just about every symptom, professional assessment, etc) and stimulants help control the symptoms, but I definitely experience an almost unpleasantly wired sensation at higher doses, and no increased relaxation at lower doses (except the relief in anxiety of being more functional). I'd be wary of trying to extrapolate your personal situation into a general rule. A couple years of ADD support groups makes me think there's a lot of variation in response to stimulants.
posted by BrotherCaine at 9:32 AM on July 3


When he was in high school, my younger brother was prescribed same for what his doctor thought might have been narcolepsy or chronic sleep disorder (I'm fuzzy on the details, but it was not for anything like ADHD). He said the drug made him feel on edge and kind of angry all the time; he found that unpleasant and asked to be taken off the rx. This was probably for the best in his case.

FWIW, this was absolutely my experience with Ritalin. Hated it. Hated it. Spent a month trying to get used to it, feeling over-focused (I couldn't task switch) and zoned out and unable to eat. Switching to a non-stimulent made a world of difference for me and absolutely improves my quality of life. Mornings are no longer a constant source of frustration and anger! (Now they are simply tiresome and unpleasant.) Now I know where I put my keys! I only need to own one hairbrush! I didn't know those were things you could do!
posted by maryr at 9:41 AM on July 3


that's the joy of different people and different formulations

Yeah, exactly, which is why I find endless declarations of IT'S ALL THE SAAAAME YOU DELUDED JUNKIE FOOLS to be so mockworthy.
posted by elizardbits at 9:46 AM on July 3 [3 favorites]


[Lily] forgot who she was, developed acute anxiety, and damn near lost her mind, if not her soul.

SHE LOST HER SOOOOOOOOOOOOOOUL.
posted by maryr at 10:12 AM on July 3 [1 favorite]


louche mustachio: "It says AMPHETIMINE SALTS/ AMPHETIMINE AND DEXTROAMPHETIMINE right on the bottle, in ALL CAPS. I don't imagine that there are too many people who are in denial about what it is they are taking."

I sometimes prescribe Adderall ("ADD For All"). When I talk about it to patients, I refer to it as "amphetamine" or "amphetamine salts". Most people accept this but some people will insist, sometimes forcefully, in referring to it as "Adderall", and even correct me. For me, that's a useful diagnostic.
posted by meehawl at 10:21 AM on July 3 [2 favorites]


SHE LOST HER SOOOOOOOOOOOOOOUL

There are support groups out there for that might be able to help.

I'm sorry. I am making light of the article writer's phrasing, not the horrible time this woman had.
posted by chambers at 10:26 AM on July 3


I sometimes prescribe Adderall ("ADD For All"). When I talk about it to patients, I refer to it as "amphetamine" or "amphetamine salts". Most people accept this but some people will insist, sometimes forcefully, in referring to it as "Adderall", and even correct me. For me, that's a useful diagnostic.

A diagnostic for what? Making sure you're prescribing what they think you are?
posted by Sys Rq at 10:27 AM on July 3


Most people with ADHD can take a low dose of a stimulant medication and gain a measurable improvement in their symptoms. Unfortunately for the writer of the linked article, there is no pill that will make someone less of a stupid asshole. I'm blame his or her parents for not being stern enough.
posted by humanfont at 10:41 AM on July 3


Sys Rq: "A diagnostic for what?"

The psychodynamics of psychopharmacology are complicated, and the proportion of the effect size associated with prescriber-patient interactions can be surprisingly large, and this proportion can vary significantly with different classes of medication. When I am considering prescribing a medication, as well as pharmacologic data, I am also considering psychologic data. Since the effect size and NNT for amphetamines is so much larger than for many other psychiatric drugs, the psychologic saliency is proportionately reduced here.
posted by meehawl at 10:45 AM on July 3 [2 favorites]


With ADHD, the medicine makes you calm and capable of focus. Without ADHD, or with a bad medicine fit, you're getting a powerful stimulant, with all of the "fun" side-effects.

No that's not correct. Someone without ADHD who takes an appropriate dose of ADHD medication will also see an increase in their ability to focus. And someone with ADHD will get all the "fun" side effects if they take a high enough dose, just like someone without ADHD.

Taking stimulants for ADHD is absolutely appropriate and helps people out immensely I just wish we could all agree on basic facts. While it's becoming less common on Metafilter a lot of people out in the wild refuse to accept how similar most ADHD meds and meth are. The fact that meth is itself an ADHD med seems to have no impact on their thinking.
posted by Justinian at 11:17 AM on July 3


Sure, if I overdose my medication I could probably get high. However, it's one of the diagnostics that when I take a normal level of medication that I don't feel it at all, while most people will. Same for most stimulants -- in my self-medicating days I could drink several cups of coffee and go take a nap immediately afterwards.
posted by tavella at 11:42 AM on July 3 [1 favorite]


Well, you do feel it since I assume it helps you focus? Otherwise you wouldn't bother. But you don't get euphoric or whatever, yeah.
posted by Justinian at 11:53 AM on July 3


There's nothing magical about your brain that makes it affect you differently from everyone else

This is pretty wrongheaded IMO. If drugs all affected everyone the same way medical science would be much much easier than it is. It's hard because each person is a huge mass of unmapped idiosyncrasies.
posted by grobstein at 11:54 AM on July 3 [3 favorites]


For me, Adderall is just an anti-task-switching drug. Whatever I'm doing when it kicks in is what I'll be doing for the next 4 hours.

I can even sleep on it -- I thought that since it was a stimulant that it would help me wake up, but when I tried taking it before getting out of bed I'd just fall back asleep for 4 hours.

If I take more than my prescribed dose, I don't get high, just nasty headaches and jaw pain.
posted by Jacqueline at 12:02 PM on July 3


While it's becoming less common on Metafilter a lot of people out in the wild refuse to accept how similar most ADHD meds and meth are. The fact that meth is itself an ADHD med seems to have no impact on their thinking

Meth is something bought from a dealer with an imprecise dosage, chemical makeup and without the advice or consent of a treating physician. Meth is not medicine. Methamphetamine is a chemical found in some varieties of "Meth", but then so is starter fluid. Americans lighting up their grills this weekend aren't cooking with meth.
posted by humanfont at 12:07 PM on July 3 [3 favorites]


Sure, and someone who is grinding up vicodin and performing a cold water extraction isn't taking medicine either but that's still hydrocodone they're taking.

You're exaggerating how impure most meth people buy often is. I believe they tested a bunch of seized meth 7-8 years ago and found it averaged something like 70% pure. It's likely more pure now since we've decided to make it so hard for people to buy pseudoephedrine which means manufacture has moved to mexican drug cartels rather than locally sourced. Those aren't Walter White levels, sure, but it's still something you can reasonably call methamphetamine.
posted by Justinian at 12:30 PM on July 3


I googled it to make sure I was remembering properly and, yeah, the average purity has fluctuated over the years but bounces around from like 45% up to 80%. Can't find any info for the past 7 years or so which is what I'd really like to find.
posted by Justinian at 12:36 PM on July 3


>>> I sometimes prescribe Adderall ("ADD For All"). When I talk about it to patients, I refer to it as "amphetamine" or "amphetamine salts". Most people accept this but some people will insist, sometimes forcefully, in referring to it as "Adderall", and even correct me. For me, that's a useful diagnostic.

>> A diagnostic for what?

> The psychodynamics of psychopharmacology are complicated, and the proportion of the effect size associated with prescriber-patient interactions can be surprisingly large, and this proportion can vary significantly with different classes of medication. When I am considering prescribing a medication, as well as pharmacologic data, I am also considering psychologic data. Since the effect size and NNT for amphetamines is so much larger than for many other psychiatric drugs, the psychologic saliency is proportionately reduced here.

Sorry, this doesn't make sense to me. What exactly do you glean from whether or not the person is assertive about terminology?
posted by Westringia F. at 1:09 PM on July 3


I think meehawl is saying that people who can't deal with it being referred to as amphetamine are less likely to have it prescribed. Or less likely to benefit. Or something.
posted by Justinian at 1:28 PM on July 3 [1 favorite]


> a lot of people out in the wild refuse to accept how similar most ADHD meds and meth are.

And dextromethorphan, in much wilder use, is used to control a cough, yet it is both a hallucinogen and a SSRI - Yet you don't see people come out in as much force insisting that we acknowledge that cough medicine is basically PCP, nor is anyone ostracized for using it properly. You will find many similarities between the two - Maybe just as many as you would find in-between, say, ritalin and methamphetamine.

I do not understand why this desire to have me and those like me "accept how similar most ADHD meds and meth are" - We get enough shit as it is, having a condition that a significant chunk of society believes to be made-up, without having to indulge anyones desire to hear that we might as well be taking one of the most demonized street drugs of our time. This is why I would generally keep my ADHD a tightly guarded secret, and I just dread telling anyone more and more as time goes on.... It's like this is the only class of meds that you will get shit for taking as prescribed.
posted by MysticMCJ at 1:57 PM on July 3 [12 favorites]


Not at all paradoxically given their efficacy as diet drugs, stimulants used to treat ADHD are associated with obesity:
Past research has suggested that children with ADHD are at higher risk of obesity than those without the disorder. Now, new research from the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, suggests that this increased risk may be a result of ADHD treatment, rather that the disorder itself.
...
Stimulant use 'leads to rapid BMI growth later in adolescence'
And intriguingly, that is something stimulant use seems to have in common with schizophrenia: Obesity 4 Times More Likely in Schizophrenia Patients.
posted by jamjam at 2:03 PM on July 3


And dextromethorphan, in much wilder use, is used to control a cough, yet it is both a hallucinogen and a SSRI - Yet you don't see people come out in as much force insisting that we acknowledge that cough medicine is basically PCP

Because people get high off DXM all the time and it's already widely acknowledged and is chemically quite different than PCP?
posted by Justinian at 2:21 PM on July 3


Also, I think you should be able to take amphetamines whenever you want for ADHD. Of course I also mostly think you should be able to take amphetamines whenever you want without ADHD so.... (shrug).
posted by Justinian at 2:22 PM on July 3


Not at all paradoxically given their efficacy as diet drugs, stimulants used to treat ADHD are associated with obesity:

I'm averse to getting journal articles reported on for me by news sites because they so often poorly interpret data, results, and research terminology, and 'cause they seem to think everything written in the "conclusions" section is actually 100% conclusive. Full text is paywalled but the abstract says by the end of the study both groups of ADHD kids (stimulant-treated and non-treated) had higher BMI's than kids without ADHD. The stimulant-treated group had a slower or delayed weight gain and ended up heavier on average than the non-treated group, but that seems to just reinforce the correlation between ADHD and long term weight issues rather indicate than anything specific about stimulant treatment. A couple of followup letters from other clinicians questioned it as well.
posted by hegemone at 3:06 PM on July 3


I'm averse to getting journal articles reported on for me by news sites because they so often poorly interpret data, results, and research terminology
...
A couple of followup letters from other clinicians questioned it as well.


I, on the other hand, am inclined to be skeptical of defenses of a practice by those who make money doing it, and would suffer damage to their professional reputations should that practice turn out to be harmful.
posted by jamjam at 3:46 PM on July 3


Justinian: " Or something."

Definitely 'something'. It's a diagnostic and not a prognostic. That depends on the situation: the person, the presenting symptoms, the history of response to similar medications, history of family response, history of compliance with medication prescription, affordability, strength of therapeutic alliance, any history of repetitive, patterned change in therapeutic alliance, level of dysfunction with tolerability and likely level of recompensation and progression if taking the drug. And for amphetamines especially, cardiovascular health and risk factors.
posted by meehawl at 4:19 PM on July 3 [1 favorite]


AFAIK, a low to moderate amount of any stimulant has the same effect on everyone. You're going to be more attentive, more alert, more focused, and perhaps a bit more talkative.

I'd expert more nuance from a fan of Shulgin's!

Tell that to the ADHD patients who tend to find Adderal or Ritalin / Methylphenidate "too jittery" or "too weird." They tend to gravitate towards one or the other, or end up on something like Wellbutrin or Strattera. For me, AMP is a bit much, even tiny doses. Methylphenidate is where it's at for me.

Ritalin is more similar in action to cocaine than amphetamines. There are marked differences between the two, but certainly about the same abuse potential.

The difference with meth is primarily that it's rather trivial to take a recreational dose that
will have you bouncing off the walls for 8 hours (or 8 weeks.).


No. That's not "the difference" at all, any more than "the difference between bath salts and ADD drugs is that crazy people use bath salts." No, it's more complicated, you know better. And, research cannabinoids are incredibly pro-psychotic compared to say, THC, for similar reasons. This is basic pharamacology. JWH-081 is not THC.
Both amphetamine and methamphetamine are potent CNS stimulants with a few biomolecular targets and affected transporters in common; however, there are important pharmacodynamic differences between the two compounds.[Refnote 2] Both compounds are potent trace amine-associated receptor 1 (TAAR1) agonists (causing non-competitive inhibition of DAT, NET, and SERT) and inhibitors of VMAT2, SLC22A3, and SLC22A5.[Refnote 3] However, methamphetamine appears to bind at a different site at VMAT2 than amphetamine.[63] Methamphetamine also inhibits VMAT1, has agonist activity at all alpha-2 adrenergic receptor and sigma receptor subtypes, and is directly toxic to dopamine neurons in humans, whereas there is no evidence of acute amphetamine toxicity in humans.[25][30][47][53] Sigma receptor activity is known to potentiate the stimulant and neurotoxic effects of methamphetamine.[53][54]
Don't kid yourself, if you're taking ADD meds, you're using speed.

This is the same reasoning used to tell pain patients they're using "hillbilly heroin" or whatever. Oxycodone is not heroin, hydrocodone is not heroin, tell a heroin addict just how awesome it is to have either of those as their backup, or a meth addict that you scored some Adderal to get him through the day. Barely gonna cut the mustard.

Truly, the difference is that "speed" has been used for a long time to refer specifically to regular dextroamphetamine, but there's clearly a stigmatization implied with your "don't kid yourself" paternalism.

There's nothing magical about your brain that makes it affect you differently from everyone else.

Welcome to 21st century psychopharmacology, epigenetics, pharmicogenetics, etc. You are wrong.
posted by aydeejones at 5:14 PM on July 3 [4 favorites]


Definitely 'something'.

OK, so, I'm still confused - how does conflating a little known technical term for a widely prescribed name-brand medicine with a term widely misused by law enforcement and associated with illegal drug use, and then watching the patient squirm, help with their treatment? It must be a very sophisticated practice, as you are pulling out all of the stops on the med-school vocab.

I suppose getting all passive aggressive with patients as you write the scrip is better than explaining straight up that you believe there are better options to treat them than medicine, so you won't be giving them medicine today. I mean, that's what my doc did when I went to him with a sore shoulder looking for a cortizone shot - he told me to ice it every night instead for two weeks, and explained why he thought it would work. He's honest with me, so I did it, and now my shoulder is better. He's old fashioned tho, not as sophisticated.
posted by Slap*Happy at 5:15 PM on July 3 [3 favorites]


I will say that meth can be indicated for ADHD and was originally prescribed quite often, but the abuse potential is much higher than regular amphetamines, the cardiovascular effects more intense, marked neuotoxicity, etc. So yes, there's a reason why dextroamphetamines and salts like Adderal are more used for this purpose now. The main innovation in "evergreening" is in Vyvanse, which just slows down the process by attaching an amino acid to a dextroamphetamine molecule, so that the digestive system has to break it down.
posted by aydeejones at 5:16 PM on July 3 [1 favorite]


I, on the other hand, am inclined to be skeptical of defenses of a practice by those who make money doing it, and would suffer damage to their professional reputations should that practice turn out to be harmful.

Right on, that's entirely valid. My background is more environmental than physiological, did you find specific critiques from either of them questionable or red-flaggish? Some of the points they raised were questions I wondered about after reading the abstract, but without being able to read the full text I'm admittedly just getting bits and pieces of a larger discussion.
posted by hegemone at 5:21 PM on July 3


The sketchiest fact about Adderal is that one of the salts is a saccharate, which makes it sweet to the taste. And since amphetamine salts are easily absorbed through insufflation, Adderal-abusers who snort the pills actually get a sweet post-nasal drip, and they tend to like that. Interesting that a bitter pill would be given an artificial sweetener, simply because it's "another salt" of amphetamine that could be put into a patented mix (decades ago, off-patent now).

The other thing is that there's little evidence to support using the levorotary version of any amphetamine for this sort of treatment, and evidence that increases negative cardiovascular effects, etc. It might benefit the depressed who cannot get out of bed in that it may affect noradrenaline, but basically the original dextroamphetamine was suitable for this use, it went off-patent, so they made a racemic mix and threw some sweetener into it. That is quite weird but it was an easy way back then to manipulate molecules and re-patent without a whole lot of advanced o-chemistry involving methyl groups and benzene rings and so forth.
posted by aydeejones at 5:24 PM on July 3 [1 favorite]


Most people accept this but some people will insist, sometimes forcefully, in referring to it as "Adderall", and even correct me. For me, that's a useful diagnostic.

Your post is a useful diagnostic as well. I have diagnosed you as "judgmental prick". I'm sorry, but there's no medication that will help you.
posted by elsietheeel at 5:24 PM on July 3 [2 favorites]


See also methanol v. Ethanol
posted by aydeejones at 5:37 PM on July 3


From TFA:
The difference between them boils down to one methyl-group molecule that lets crank race a little faster across the blood-brain barrier and kick just a little harder. After that, meth breaks down fast into good old dextroamphetamine

Also, that is not "the difference" either. It's one difference among many that adds up to the "mule kick," the actual toxicity in the brain, and the addictive potential. Methanol has a much bigger kick than "ethanol" too, and will literally leave you blinding drunk. They are very, very similar. But they are not the same thing.

The blood-brain barrier "race" is a small factor in how methamphetamine overwhelms receptor sites and causes actual neurotoxicity and cell death. The Wikipedia article goes into great detail, and it's very similar to the reasons why research cannabinoids like JWH-081 are so neurotoxic and prone to acute psychosis.

Furthermore, a markedly small concentration of the drug is excreted as regular amphetamine and meth is MORE active, rather than some silly pro-drug that gets metabolized into something more potent as seen with codeine, hydrocodone etc; it's pretty challenging actually to convert meth to regular amphetamine or vice versa. Meth is favored in clandestine operations because it is more potent gram for gram, it is easier to synthesize, and has more cachet as a smoked / IV type drug. If it was worth the trouble to cook up regular speed they would do it, and it's not for competition with the pharmaceutical industry that they don't bother (see heroin vs. oxycodone).
When taken orally, 30–54% of the dose is excreted in urine as methamphetamine and 10–23% as amphetamine.[66] Following IV doses, about 45% is excreted as methamphetamine and 7% as amphetamine.[66] The half-life of methamphetamine is variable with a mean value of between 5–12 hours.[7][66]
This is not reefer-madness "brain damage!" concern trolling, either, and to some extent explains why meth addicts find nothing else will ever touch the high they obtain through meth (beyond its mere potency):
Unlike amphetamine, methamphetamine is neurotoxic to humans, damaging both dopamine and serotonin neurons in the CNS.[i] Contrary to the long-term use of amphetamine,[iii] there is evidence that methamphetamine causes brain damage from long-term use in humans;[ii] this damage includes adverse changes in brain structure and function, such as reductions in gray matter volume in several brain regions and adverse changes in markers of metabolic integrity.[ii]
posted by aydeejones at 6:17 PM on July 3 [2 favorites]


...aaand one more thing, from the article about plain-jane amphetamine:
At normal urine pH, the half-lives of dextroamphetamine and levoamphetamine are 9–11 hours and 11–14 hours, respectively
The uninformed might say "but meth has a shorter half life and present in the body for shorter periods of time, 5-12 hours vs. 9-11 or 11-14."

Yes, that makes it more addictive. The half life is incredibly variable, causing demand for the drug at random intervals. It disappears more quickly, prompting more frantic re-dosing. The re-dosing can occur before the user has a tendency to want to sleep. It goes on and on. They are very, fucking, different.
posted by aydeejones at 6:20 PM on July 3


I have found that Vyvanse works much better than Adderal. It works for 12 hours so I didn't need the evening booster dose. Also kicks in more slowly and leaves less abruptly.
posted by humanfont at 6:22 PM on July 3


I will bow out after this, but that makes a lot of sense, knowing the long half-life of regular amphetamine, combined with the digestion delay it takes to remove the lysine amino acid from the amphetamine molecule. Vyvanse is a pretty clever solution, it can be abused orally, but is basically useless in all other forms. Route of administration is a big deal, so it does address empath's point that meth tends to be taken in higher doses, and through much more "firey" routes that hit the body in high concentrations. But gram for gram, IV pure AMP vs. Meth is going to demonstrate a clear "winner," and the fact that the "winner" is so aggressively active in the brain probably lends some explanation of why it actually is neurotoxic and not simply an agonist, blocker, re-uptake inhibitor, etc.

The article about Methylphenidate used to make the point that it's more similar to cocaine in mechanism of action, but it still does draw the clear distinctions between Methylphenidate (a "substituted phenethylamine") and amphetamine ("a sympathomimetic amine and typical phenethylamine"). That's all blah-de-blah but the point is structural similarities only take you so far, which is why Shulgin preferred to "bio-assay" his creations himself.
posted by aydeejones at 6:28 PM on July 3


>>>>> ... Most people accept this but some people will insist, sometimes forcefully, in referring to it as "Adderall", and even correct me. For me, that's a useful diagnostic.

>>>> A diagnostic for what?

>>> The psychodynamics of psychopharmacology are complicated, and the proportion of the effect size ....

>> Sorry, this doesn't make sense to me. What exactly do you glean from whether or not the person is assertive about terminology?

> It's a diagnostic and not a prognostic. That depends on the situation: the person, the presenting symptoms, the history of response to similar medications, history of family response, history of compliance with medication prescription, affordability, strength of therapeutic alliance, any history of repetitive, patterned change in therapeutic alliance, level of dysfunction with tolerability and likely level of recompensation and progression if taking the drug. And for amphetamines especially, cardiovascular health and risk factors.

That's a lot more word salad, still not answering a simple question. Again:
What is a person "insist[ing], sometimes forcefully, in referring to [amphetamine] as 'Adderall'" a "useful diagnostic" for?
posted by Westringia F. at 8:46 PM on July 3 [4 favorites]


I think this thread has exposed, as the writer intended, some quite strong, deeply held and very divergent opinions about the ethics and morality of stimulants contemplated as supplied variously unregulated, illicit, or controlled. I'm sorry if my explanation of some of the factors that influence my decision to recommend or not recommend a therapy to a particular patient are interpreted by some in a negative fashion. One of the drawbacks of so much specialised schooling and vocabulary is that it's difficult to communicate complicated concepts across when you lack a common frame of reference, and when you are not in the room, with a specific patient, and with a relationship between you, then it's even harder to talk meaningfully about the practice parameters and some people seem too eager to give voice to and bring in their own negative experiences here. It may have been simpler right at the start to say "It's complicated" and leave it at that. I'm not going to respond to personal insults and I'm going to withdraw from discussing the mechanics of controlled amphetamine prescribing because it seems to be distracting. Amphetamine can produce psychosis, or even death, and I've seen that, but I've also seen it restore some people to health and productivity and eliminate suicidal depression. I'm going to go on evaluating each person, each time, with diagnosis and prognosis, and recommending it when I think it's appropriate, and recommending against it when I think it's inappropriate.
posted by meehawl at 10:20 PM on July 3 [1 favorite]


I do not understand why this desire to have me and those like me "accept how similar most ADHD meds and meth are" - We get enough shit as it is, having a condition that a significant chunk of society believes to be made-up, without having to indulge anyones desire to hear that we might as well be taking one of the most demonized street drugs of our time.

I prefer that to the years of having the discussions with teachers, such as "What happened? You could easily ace this class in your sleep! Your tests, quizzes, and participation all show you know this stuff backwards and forwards, but why can't you get your papers and projects in on time? Is it laziness? Are you happy with B's when with just a little effort you could be skipping entire grade levels? I don't understand... it's not like you need a tutor or anything. Just apply yourself!"

Lazy. I hated that classification. I worked hard to not be seen as that and developed a reasonable set of skills to cope with it, without even knowing that there might even be a condition to explain it. Had I been born a bit later, I probably would have been prescribed it at 12 instead of 21, when I discovered that a couple of my friends had similar challenges and patterns of thought but had been helped greatly when they were diagnosed. I did a great deal of research on my own and have a few appointments with doctors to figure out if it was worth trying a medication to see if it would help, and it turned out it did. Before I was diagnosed, it was like having a hard time making out details at distances, like the blurry words on small street signs more than 100-150 feet away for example, and not knowing about this invention called 'glasses' or a condition called 'nearsightedness' and being told "you're not even looking, are you?"
posted by chambers at 10:21 PM on July 3 [7 favorites]


One of the drawbacks of so much specialised schooling and vocabulary...

You learned "ADD-For-All" in med-school? Or we were just supposed to kinda, I dunno, ignore the paper on drug inefficacy (for treatment-resistant depression, and not ADHD) you linked? Now, I'm just an art-school drop-out, and just because I've had a run of beyond exceptional doctors to work with and completely abysmal ones to compare them to doesn't mean I should be all rushing to any kinda judgement on someone who's clearly more schooled than I am.

So, please. Explain for everyone's education and benefit. How does making a patient feel as if they're abusing illegal drugs help you judge the proper medicine and dosage to prescribe to them? It may be a chore, but could you lay it out in layman's terms?

Not speaking from any kind of bad experience with the mental health profession here, oh no, not me...
posted by Slap*Happy at 11:31 PM on July 3 [3 favorites]


meehawl, you may have checked out already but if not:

You keep misreading the question being asked. As far as I can tell, the original question was just "what would the two particular responses mean to you?" and not "what is the general rationale for using that conversation as a diagnostic tool?" A simple clarification would be along the lines of "One response leads me to think ___, the other might suggest ___."

A really excellent care provider will have solid empathic inference skills and can use them to communicate effectively, as well as educate in relatively simple language. A not-great provider will lack the ability to accurately assess their patients' thoughts and feelings and will communicate in opaque language, which can read as dismissive. You've demonstrated traits of the latter here, and that casts some doubt on your ability to mind-read your patients' responses, if not the usefulness of that diagnostic in the first place. This may be why people are reacting negatively to your comments.
posted by hegemone at 8:12 AM on July 4 [2 favorites]


What I think meehawl was trying (or trying not) to say is, patients who demand specific medications by brand name rather than describing their symptoms and listening receptively to their doctor's recommendations are likely to benefit less from that conversation; and that given the minimal testable effectiveness of many medications the conversation is often the cure; but that since methamphetamines have real power it's probably OK to just give the patient what they're asking for.

This is reasonable, but not something doctors generally discuss in public, so they don't all know how to say it simply. Although, I'm a little concerned that meehawl may think that a higher NNT means greater effect – it's the number of people you need to treat to get one more good outcome than a placebo, so lower is better; not enough doctors understand it well.
posted by nicwolff at 9:06 AM on July 4


nicwolff, I could understand that in regards to the specific kind of medication. I.e., when I first got formally diagnosed, the doctor and I discussed medications; she said that depending on the person either stimulants or antidepressants might be used. Because of my history of self-medication with caffeine, novelty, and panic, I was pretty sure stimulants were the way to go and said so. She agreed, and recommended starting with ritalin IR and seeing how that went. So yeah, I could see it meaning something if a patient marches in and says "Give me ritalin/adderall" from the start.

But from their post, what meehawl is doing is going "I'm going to prescribe you meth and how is the meth going for you" and then taking it as meaning something if the patient is uncomfortable with the generic name and prefers to use the brand name. And that's kind of ugly, basically saying "accept that you are a sinful druggie!", which is going to push some people to feel like they need to give up medications that will help them. Sure, in a perfectly rational world you could use the same drug names and people would feel no impact from them, but people are rarely perfectly rational, especially after a multi-decade 'drug war'.
posted by tavella at 10:32 AM on July 4 [2 favorites]


I don't care whether or not I have a special illness;* Adderall, a.k.a., amphetamine, a.k.a. speed, makes life and work possible. Improved focus, and relief from chronic fatigue. Wish I'd had it years before. It's not too hard on the body, my evening glass of wine probably takes a greater toll on my body. Using it to study or to work more effectively doesn't seem too terrible, there's a popular drug to help men get erections, why is a drug that helps you perform other tasks so bad?

* properly diagnosed, yadda
posted by theora55 at 10:58 AM on July 5 [5 favorites]


I'm not re-entering, but I've received a long and quite unhinged email from an individual not immediately identifiable from this thread saying they will "report" me to my local medical board for stating "ADD For All" as "improper diagnosing that is complete malpracticing". Please note that "ADD For All" was the tagline and ADHD-focussed drug moniker selected by Roger Griggs at Richwood, as a way of re-branding Rexar's amphetamine mixed salts compound Orbetrol, originally marketed as an obesity drug (and which by that time no longer contained methamphetamine, but had in the recent past). This serves as notice that I in no way assume or assert that "ADD" is a universal diagnosis, or one that can be made remotely without patient contact. ADHD is a clinical diagnosis that can legally only be made by a qualified clinician after a personal exam and history-taking, and may include self-report or neuropsychological testing.
posted by meehawl at 10:40 PM on July 6 [1 favorite]


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