> first, their whole business model is about being a pill farm for controlled substances
Before COVID, you couldn’t get a prescription for controlled substances without first meeting a provider in person.
This law was enacted years ago because pill mills were popping up everywhere and dispensing controlled substances to people in exchange for $200+ phone calls. They’d do a minimal 5 minute call with anyone who signed up, speedrun through a prepared script, and then send the patient their controlled substance prescription of choice. You then made a follow-up appointment the next month for your refill, which was an even shorter phone call.
They didn’t accept insurance because no sane insurance company would deal with them. Their target audience only wanted to pay their way to prescriptions and didn’t mind.
And this is exactly what Cerebral is doing all over again. The COVID exceptions for in-person prescribing will theoretically expire at some point, but until they do there are several companies like Cerebral trying to cash in as much as possible with Instagram and TikTok ad campaigns to convince as many people as possible to sign up for literal Adderall pay-for-prescription subscriptions.
Before anyone rushes off to sign up, keep in mind that these controlled substance prescriptions will be logged in your state’s prescribing database and doctors everywhere are catching on to these pill mills. If you show up to a real doctor later asking for a prescription, they might check your prescribing history and think twice after seeing that you were getting prescriptions from known pill mills nowhere near you.
Pharmacies are also getting fed up with the sudden influx of prescriptions from remote doctors for scheduled substances.
I really hope this business model gets crushed ASAP, because if it’s allowed to continue then we’re going to see a crackdown on ADHD diagnoses and prescribing in the same way that pain management has become exceedingly difficult to come by (for true pain patients) in the wake of the opioid pill mill epidemic.
The most commonly prescribed medication for ADHD is pharmacologically essentially the same as meth. It affects us ADHD people differently than the rest of the population.
> The most commonly prescribed medication for ADHD is pharmacologically essentially the same as meth.
I'm not sure about that. If I remember correctly, the most prescribed medication for ADHD is Adderall, and Adderall is amphetamine salts. Amphetamine and methamphetamine are not the same, though they are close. Also, the difference between a therapeutic dose of amphetamine or methamphetamine and what the regular drug abuser uses is huge.
I'm not at my home computer so I'm not able to pull up citations, but there is a paper I have read in which they gave meth addicts amphetamine-based ADHD medication vs typical equivalent street doses of meth in a double-blind study, and the meth addicts reported them as basically equivalent. I say "basically equivalent" because they were not indistinguishable due to different formulations having noticeably different durations of effect, but the high they produced and the side effects were basically the same. This study was a pretty big deal because it demolished the widespread assumption that the methyl- group makes methamphetamine more neurologically potent.
So yeah, aphetamine (Adderall et al) and meth are basically the same, pharmacologically. The anticipated differences between them in their effect on the body and mind largely aren't real.
Most studies I've seen of methamphetamine for ADHD treatment use 20-40mg doses, sometimes but not necessarily split in two. A google search seems to claim that abusers take up to 50mg at a time. That's not a lot higher than the prescribed dose.
I'm a physician who's prescribed medications for many ADHD adults. Methamphetamine (MA) is legal to prescribe for ADHD and indeed a few patients had best results with it. MA isn't "stronger" than D-amphetamine but may be better tolerated. AIUI the main reason MA is the dominant street amphetamine-type drug is that it's easier to synthesize in clandestine labs vs. classic amphetamine. At equivalent doses the effects are similar.
In any case you're right that there's a big difference in street drug use vs. therapeutic doses. For street drug user a typical daily dose is on the order of 1000mg whereas prescribed doses are with few exceptions 1-2 orders of magnitude below that. MA in particular is in the lower end of the range, I'd say 10-20mg/day (partly due to it being a very expensive pharmaceutical product if in fact it's even being manufactured at present).
Only a small portion of methamphetamine users are using a full gram in a single dose. Perhaps spread over a day or two, but most recreational doses are closer to 100mg
I've seen the same thing as you for methamphetamine and amphetamine being "basically equivalent" but it was a study in rats. However, patients usually rate desoxyn (which is methamphetamine) higher (~10% higher) than either adderall or dexedrine (another amphetamine), and methamphetamine is supposed to be better at crossing the blood brain barrier. I'm not sure if I would call it equivalent/the same but they're very close. Especially this part:
> The anticipated differences between them in their effect on the body and mind largely aren't real.
You're totally right about that. People associate methamphetamine with drug abuse and amphetamine with people taking adderall, but I think it's a case where the dose makes the poison.
For the abusers parts, I've found Simon et al, 2001 "A comparaison of patterns of methamphetamine and cocaine use", that would indicate doses of 500 mg, usually snorted instead of "eaten". As an anecdote, a friend that used to abuse amphetamine consumed around 300 mg a day.
...and even for us, there are side effects. Concerta made me irritable and I wouldn't eat anything. I know someone who was on Focalin for a while and they suffered from awful mood swings and depression. I've been on the same dose of Vyvanse for 10 years and I still get occasional mood swings.
I'm not on anything, and I get occasional mood swings too. ;)
My point: For many of these substances, I'm perfectly capable of managing my own dosing, side-effects, and knowledge resources without a government-mandated overseer. Maybe the solution is to deregulate & facilitate access to knowledge providers, but not enforce more regulation.
I think we should get rid of the Controlled Substances Act and the DEA. Everything should be available over the counter from a pharmacist on request. (I'd still involve the pharmacist because they're a professional at identifying drug interactions and such, but you shouldn't require a scrip to get access to medication.)
But in your original comment you asked if there is any evidence that there is adverse effects from excess prescriptions. And, well, there's plenty of adverse effects from meth use (source: every trailer park in small town America). And studies have shown that the amphetamines commonly prescribed for ADHD produce an indistinguishable high amongst recreational users.
So if you made these drugs unscheduled and available over the counter, you'd basically just replace drug cartels and your local dealer with the Pharma industry and your local CVS. Which don't get me wrong, is a massive fucking improvement! I'm all for that. But you'd certainly also have a heck of a lot of meth-heads wrecking their lives with over-the-counter meds.
Any such legalization and normalization would require active community support and intervention to help substance abusers too.
My only resistance to that idea is this: Passing that law would invariably result in some deaths.
Sure, it would primarily be the people who had no control over themselves in the face of their addictions, but making all drugs legal would cause many, many people to either overdose or to keep taking the drugs until they died from secondary effects.
If that could be mediated, I am all for full legalization of all drugs, including "hard" drugs like cocaine and heroin.
Other countries have done similar things and found a decrease in usage among both new and previous users, a decrease in overall drug-related deaths, a decrease in drug-related crime, and an increase in rehabilitation.
I may not approve of using drugs myself, but I think what I do with myself is my business and what others do with themselves is their business. I would prefer for things to be as good as they can be with the goal of getting better, and broad scale legalization has strong potential to be a step in the right direction.
Not passing that law has already resulted in needless deaths (lookup the history of HIV antivirals and the FDA to see what I mean). Don't forget to account for the opportunity cost of inaction.
I can't quite classify it but I feel that there is an ethical line between the deaths that are occurring because of a person's flaunting of a law and the deaths that would occur because of a law being changed.
As a terrible analogy, if we made it against the law to wear seat belts, some people would die who would not otherwise die.
Most people would continue to wear seat belts anyway as they are aware that wearing a seat belt is far safer than not wearing a seat belt.
Further, it makes sense that a large portion of those people who would die would be the ones that weren't wearing seat belts to begin with regardless of the law, but it stands to reason that some percentage of people who die would be people who would have worn seat belts but chose not to because it was no longer illegal to drive without a seat belt.
I feel there would be a similar outcome to mass drug legalization. Most people would have no change in their lives. Some people who were subconsciously mid-drug induced suicide would continue on and die quicker thanks to the ease of access and legalization, but there would be some people who, without the legal issues and difficulty of obtaining the drugs being an inhibitor would then choose to indulge, and some fraction of those people may overdose or otherwise harm themselves where they would have been protected by the current status quo.
It's hard to navigate mentally but I feel confident in the statement even if it is not fully formed.
I'm also on Vyvanse. Side effects are thankfully minimal compared to some of the horror stories I've heard. But I do have trouble sleeping, routinely rub my tongue raw from bruxism, and if I accidentally have any caffeine I feel like my heart is going to explode. But it is way better than being off medication.
Before COVID, you couldn’t get a prescription for controlled substances without first meeting a provider in person.
This law was enacted years ago because pill mills were popping up everywhere and dispensing controlled substances to people in exchange for $200+ phone calls. They’d do a minimal 5 minute call with anyone who signed up, speedrun through a prepared script, and then send the patient their controlled substance prescription of choice. You then made a follow-up appointment the next month for your refill, which was an even shorter phone call.
They didn’t accept insurance because no sane insurance company would deal with them. Their target audience only wanted to pay their way to prescriptions and didn’t mind.
And this is exactly what Cerebral is doing all over again. The COVID exceptions for in-person prescribing will theoretically expire at some point, but until they do there are several companies like Cerebral trying to cash in as much as possible with Instagram and TikTok ad campaigns to convince as many people as possible to sign up for literal Adderall pay-for-prescription subscriptions.
Before anyone rushes off to sign up, keep in mind that these controlled substance prescriptions will be logged in your state’s prescribing database and doctors everywhere are catching on to these pill mills. If you show up to a real doctor later asking for a prescription, they might check your prescribing history and think twice after seeing that you were getting prescriptions from known pill mills nowhere near you.
Pharmacies are also getting fed up with the sudden influx of prescriptions from remote doctors for scheduled substances.
I really hope this business model gets crushed ASAP, because if it’s allowed to continue then we’re going to see a crackdown on ADHD diagnoses and prescribing in the same way that pain management has become exceedingly difficult to come by (for true pain patients) in the wake of the opioid pill mill epidemic.