[HN Gopher] People with ADHD claim Adderall is 'different' now
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People with ADHD claim Adderall is 'different' now
Author : gnicholas
Score : 135 points
Date : 2023-03-11 18:25 UTC (4 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| therein wrote:
| I wouldn't be surprised if they are doing this. It should be
| relatively easy to test, though. I know many people that'd
| volunteer do run NMR or mass spec.
| awinter-py wrote:
| interesting -- where? guessing it would be easy to collect a
| bunch of different brands + generics to compare
| therein wrote:
| Pretty much anyone with friends who study chemistry would do.
| The problem is, no matter what you do, it is going to be very
| challenging proving the chain of custody to hold them
| accountable.
| blincoln wrote:
| I don't think it's still manufactured, and maybe it's unrelated
| to this current situation, but around 8-15 years ago, one of the
| manufacturers of generic Adderall XR did something that made it
| much less effective. It was obvious which ones were theirs,
| because they were the only company that put theirs in blue
| capsules.
|
| Subjectively, it felt about half as effective as anyone else's.
| There were many, many forum discussions at the time from adults
| taking it as well as parents of kids who'd received it and
| noticed a big difference.
|
| It was especially frustrating because of all the rigamarole one
| has to deal with to get the medication in the first place. To not
| have it work and also have to wait another month to get one that
| does is ridiculous.
|
| I submitted a complaint to the FDA about it at the time. Never
| even got a form letter back. It's caused me to avoid generic
| drugs where possible ever since because if that can slip through,
| what else can?
|
| I assumed at the time it was some difference in the capsule
| itself or the delayed-released mechanism, as opposed to the
| active ingredients being different.
| kkielhofner wrote:
| You see this with a lot of psychotropic medications (and likely
| others).
|
| It's why when you fill a generic the label will specifically
| list the manufacturer. I've heard of at least a few instances
| with psych meds where people will either try to get a specific
| generic manufacturer or go back to name brand because of the
| significant impact due to variability you're describing.
| drowsspa wrote:
| I would also say that ADHD meds are much more susceptible to
| this, because the psychological effect is just so noticeable.
| Taking Vyvanse by itself compared with taking it with a little
| snack it makes quite a difference in the absorption for me;
| when I take it with Psyllium husk, then...
| liketochill wrote:
| Then what?
| roer wrote:
| I am in a similar situation as you and trying to figure out
| the best way to take my medication. I never really thought
| about my psyllium husks having an effect, so I'm very curious
| what you've noticed
| trafficante wrote:
| As somebody approaching 40 who has been on ADHD meds most of his
| adult life and for portions of his childhood:
|
| It's not that (generic) Adderall is different so much as there
| seems to have been an explosion of generic manufacturers all
| using wildly different amounts of the actual amphetamine salts
| and binding agents.
|
| For me personally, the Mallinckrodt generic seems to use a
| different binding agent that causes bloating and occasional
| headaches.
|
| The shortage has really demonstrated just how differently these
| generics are formulated.
|
| Eg: I used to take Sandoz 20mg tablets that were about the size
| of two baby aspirins. At one point, a few months back, I was
| forced to modify my prescription so it could be filled as 10mg
| tablets.
|
| My new 10mg bottle was filled with Teva manufactured pills that
| each were roughly the size of 2.5 of my old Sandoz 20mgs -
| despite being half the dosage. That's a ton of filler.
|
| The worst part about the shortage - beyond the anxious pharmacy
| hunt each month - is that my insurance pushed a new shortage
| policy that places a moratorium on modifying ADHD prescriptions.
| I literally am not allowed to try "creative" solutions like
| Dexedrine or even something like modafanil.
| 2OEH8eoCRo0 wrote:
| As someone who has been on and off Adderall for 20 years: Why
| would I care what a bunch of psychotics _think_?
|
| > Videos of people who claim that their medication is no longer
| effective have recently catapulted through TikTok.
|
| Oh, TikTok, even better.
| favaq wrote:
| Precisely what I was thinking. This kind of hoax sounds like it
| could easily spread among crazy people.
| awinter-py wrote:
| the stuff in here about 'minor differences in coating could make
| a difference but shouldn't' is surprisingly badly researched
|
| both teva + shire manufacture a branded and a generic -- just
| _ask_ them what the difference is between the two, right? and if
| they hang up you can write, 'both teva and shire refused to say
| if their generic works'
|
| I'm fairly sure this is Shire's original patent for XR beads
| https://patents.google.com/patent/US6322819B1/
|
| they have a subsequent patent for a more continuous delivery
| system https://patents.google.com/patent/US6913768B2/
|
| (from plasma concentration, the double-pulsed one looks as smooth
| as continuous delivery, but I'm guessing the brain + blood half
| lives are different)
|
| but the bead material is probably FDA scrutinized, and any
| chemical difference between the branded + generic version is in
| theory public knowledge; shocking nyt didn't like, call a chem
| lab or something before hitting send on this one
|
| the author speculating that someone is complaining about
| switching from an immediate release to an XR also feels bogus --
| presumably I would say in my tiktok that it's a capsule instead
| of a tablet?
| hooverd wrote:
| That's like baby's first chemistry lab lesson, inactive
| ingredients can make a big difference sometimes.
| jws wrote:
| I suppose things might have changed in ~half a century, the FDA
| used to care about everything.
|
| Back in the late '80s the VAX-11/750 that was part of the
| Siemens MRI scanners was shipped in the old blue trim color
| long after DEC had switched to the very chic "brown on tan"
| color scheme. The FDA approval for the scanner would not let
| them change the color of the paint because of some bleedover of
| medication regulation language into the equipment approval
| regulations.
| thfuran wrote:
| There are whole classes of products designed to be eaten for
| various purported benefits but which are evidently neither
| sufficiently foodlike not sufficiently druglike to warrant
| FDA attention. Herbal supplements are apparently just edible
| magic.
| paulmd wrote:
| Not a doctor, just a patient:
|
| Adderall is a mixed salt, it's two stereoisomers, amphetamine and
| dextroamphetamine. One of them (I think it's the amphetamine) is
| "speedier" feeling and the other one (I think dex) is "cleaner".
|
| Dextroamphetamine is also available as a purified salt itself, as
| dexedrine. And I think that's more of a "kids medicine"
| specifically because it's less "speedy".
|
| I think there's nothing that guarantees any particular ratio
| comes in the product, and obviously generics have very mixed
| results on just how "bioequivalent" it really ends up being. I
| think the mixture is varying and people end up _feeling_ like it
| 's different because they're feeling the "speediness" change and
| that's the feeling they associate with being medicated with
| stimulants.
|
| Amphetamines are another dopamine-releasing and gaba-ergenic
| family of drugs and my suspicion is that in the presence of an
| opioid antagonist like naltrexone probably patients would not be
| able to distinguish between the exact mixtures of the
| stereoisomers but without it they probably can tell which feels
| "speedier" and the perception is that is how much their symptoms
| being treated. The dopamine-releasing loop probably is a not-
| insignificant part of how it treats ADHD though, dopamine-seeking
| is a key aspect of ADHD (do you drink caffeine or eat sugar
| before you go to bed, or when you wake up in the middle of the
| night, and then fall right asleep? that's because your brain is
| getting dopamine satiation finally).
|
| (Incidentally this all makes stims a very difficult combination
| for alcoholics and other GABA-loop drugs because the effects are
| synergistic and mask each other.)
|
| Obviously a difference in coatings should make zero difference
| but half the time there are broader problems with bioavailability
| or just generics being inferior quality in general, not just
| adderall but in general. The FDA isn't doing a good job with this
| really, just IMO, and not just with adderall. The entire
| foundation of generics rests on "this is chemically equivalent
| and absorbed the same" and it's clearly not for a lot of people
| and the generic is almost always the one that comes off worse.
| The entire product needs to be the same, binder and coating and
| all, with the same level of quality and in the case of
| stereochemistry it needs to be the same mixture.
|
| The bigger problem is just the shortages in general... my last 2
| refills have both taken 7 days past the end of of the
| prescription, and this latest one I only managed to get 1/3 of my
| prescription filled (and they won't fill the rest of the
| prescription later if you pick it up, nor will they hold what
| they have while the rest of it comes in). Leftovers and reducing
| my dose (against the instructions of my doctor) will only carry
| you so far, I can't run 50% longer on a given prescription. The
| mood swings and stress and dopamine-balance/seeking problems that
| come with bouncing off it are rough too.
|
| My doctor's office is entirely unsympathetic and views their job
| as 24-48 hour turnarounds which is obviously completely
| insufficient for this kind of situation, no way it will be on the
| shelf in 48 hours. And if I push it then I come off drug-seeking
| (yes, voluntarily taking 1/3 of my prescription per month so I
| can get something at all, definitely drug-seeking). It sucks and
| I've become very disillusioned with my doctor over this, they
| just are not sympathetic at all.
|
| Everything to do with C2s is just so tainted by the adversarial
| relationship between the DEA and doctors and that only emphasizes
| the sometimes-adversarial relationship between doctor and
| patient.
|
| If this were lupus patients struggling to get their meds during
| the height of COVID mania, there would be no concern whatsoever
| about doing what was needed to get people their meds. There would
| be no concern about other generic providers just making more,
| either. But it being a C2 changes everything. It fucking sucks
| and it's disgusting this is how a health care system works.
| sph wrote:
| Some clarification: the stereoisomers of amphetamine found in
| Adderall are _levo_ amphetamine and _dextro_ amphetamine, the
| former feels "speedier" because it mostly affects the body
| (heart rate, blood pressure, fight-or-flight response) whereas
| the latter mostly affects the brain (wakefulness, focus, etc.)
| Adderall exists because apparently a small amount of
| levoamphetamine has been shown to produce some effect on focus,
| but most of the heavy lifting is done by the right-handed
| isomer. In my opinion the risk of addiction is higher if there
| is a noticeable physical high.
|
| Which is why I personally have decided to go with
| dextroamphetamine (in the long release form of
| lisdexamphetamine) which doesn't cause any body stimulation,
| and in fact lowers my blood pressure due to reduced anxiety,
| while producing no physical stimulation whatsoever. A cup of
| coffee feels "stronger" than lisdex.
|
| In Britain Ritalin (methylphenidate) is usually first line
| treatment for children, while Elvanse (lisdexamfetamine) is
| preferred in adults. AFAIK Adderall is not prescribed here.
| capitainenemo wrote:
| The wakefulness thing has been offered as a theory for the
| doubled rate of psychosis in ADHD children on Adderall
| compared to Ritalin.
|
| https://www.healthline.com/health/adhd/adderall-psychosis
| https://www.nejm.org/doi/full/10.1056/NEJMoa1813751
|
| "Studies of Adderall and similar stimulants, such as
| methylphenidate (Ritalin), estimate that psychosis occurs in
| about 0.10 percent of users. However, new research with over
| 300,000 adolescents with ADHD showed that the rates of
| psychosis in adolescents in the amphetamine group was as high
| as 0.21 percent. "
| braingenious wrote:
| The isomers in adderall are dextroamphetamine and
| levoamphetamine. They are both "amphetamine".
|
| Last I checked it's a racemic mixture, so it'll be 50/50
| levo/dextro.
|
| Fun fact! Certain SKUs of Vicks inhalers use levo _meth_
| amphetamine as a very effective decongestant. It's literally
| methamphetamine! Just not the kind that can get you even
| remotely high.
| 1659447091 wrote:
| > and this latest one I only managed to get 1/3 of my
| prescription filled (and they won't fill the rest of the
| prescription later if you pick it up, nor will they hold what
| they have while the rest of it comes in)
|
| You can have your doctor send in a new prescription for the
| remaining amount. Whether your doctor will for you is another
| story.
|
| The way it was explained to me is a prescription of say 90
| count is -yours- for the month. You get to have 90 in a 30 day
| period. If a pharmacist can only fill 30 and you pick it up,
| the rest of that particular script is no longer valid (or
| something). But you are still good for 60 as long as your
| doctor will write a new script for that remaining amount.
|
| source: same situation couple months ago or so and a great
| doctor and pharmacist who understands the situation. I received
| a 10 day supply and had a new prescription sent in that would
| not be able to be filled until after that 10 days and only for
| the remaining amount.
| llamaLord wrote:
| In Australia we only have pure Dex. I'm not sure if I buy that
| they're a benefit in using 25% levoamphetamine vs the
| manufacturers just wanted a way to cut their product and get
| cheaper manufacturing...
| scq wrote:
| It's mostly an accident of history. Adderall was originally
| marketed as a weight loss product (!) containing 4 different
| amphetamine salts, including methamphetamine (!!).
|
| The FDA made them remove the meth in the 70s, and in the 90s
| the company that made it was acquired, and it was rebranded
| as an ADHD drug.
| bragadiru_mafia wrote:
| [flagged]
| SV_BubbleTime wrote:
| You might be shocked to find out how many tech people are on
| them. I mean... it's not exactly an unknown correlation.
| shrimp_emoji wrote:
| Coming from a culture where psychiatric medications are not
| normalized (because people simply couldn't afford them, if
| pharmacies even carried them), it is pretty disturbing how
| many people take some kind of pill. You can't help but feel
| as though so many people _shouldn 't_ have anything wrong
| with them such that they _need_ pills -- i.e., mental illness
| should not exist at such high rates lol.
|
| (And, as subtext, should be feared and stigmatized.)
| pksebben wrote:
| This is a dangerous take, and I would recommend you do the
| reading to upgrade that feeling to a thought, with all the
| relevant context.
|
| The idea that someone should be a certain way, and that
| they shouldn't need a pill, is making some heavy
| assumptions about what's needed to exist in the world. This
| is something that's changing rapidly - one can no longer
| make a comfortable living doing many jobs, and most of
| those are the kinds of things you could do if focused
| thinking isn't in your wheel house.
|
| Speaking as someone who thought that way for a long time,
| and has a severe executive functioning disorder, I can tell
| you it was wrong minded. I spent over a decade trying to
| just "push through" because I felt "I should be enough
| without it" and I didn't want to be dependent on a
| medication. I flunked out of high school and then college,
| went through a series of careers that always flopped, and
| watched my relationships fail because I couldn't keep a job
| or a schedule.
|
| At some point, I became fed up with my situation and
| started seeking help. After admitting that I might need
| this help, things got immediately better in my head, and
| then in my life. I taught myself to code and I now work in
| tech, which is the story of career I had given up any hope
| of ever achieving. I no longer struggle to make ends meet
| and I have a stable and fulfilling life, which wasn't going
| to happen unmedicated. I know this because I tried.
|
| If this isn't you, then great. But please recognize that by
| putting up barriers to others getting this stuff, we've
| almost certainly forced people like me into lives that are
| measurably worse and less productive for society than they
| could otherwise live.
| SV_BubbleTime wrote:
| If you really want to be scared, wait until you find out
| how many people get hooked as little children.
| api wrote:
| How many people wear eyeglasses?
|
| Seems reasonable that a large percentage have suboptimal
| neurological issues that can be helped by a drug for the
| same reason so many have suboptimal vision: it doesn't stop
| you from reproducing often enough to be selected out.
| SV_BubbleTime wrote:
| I don't disagree with you. But... we can tell when eyes
| are messed up by verifiable flaws in the mechanisms, we
| can literally look in and see the issue. Not exactly so
| for brain meds.
|
| Is it the most fair comparison you can make?
| faeriechangling wrote:
| Regarding generic equivalents - let me give a little history
| lesson:
|
| For Methylphenidate based medications, Ritalin, Ritalin LA, and
| Concerta all have the same active ingredient. However patients
| were willing to pay extra for Concerta due to it having the OROS
| delivery system which delivers the medication over an unusually
| long period of time of 12 hours in a very steady way.
|
| However in the US, the FDA allows medications which deliver
| within 80% to 125% of the same medication to qualify as a
| generic. A bunch of generics for concerta which did NOT use the
| OROS delivery method but instead used cheaper inferior methods
| which did not deliver medication as steadily or for as long were
| released simply because they were within that 80% to 125% window.
| In fact these generics were more similar to Ritalin LA than they
| were Concerta, so essentially the FDA allowed essentially a
| different drug to be substituted for Concerta when the ENTIRE
| POINT of Concerta for many patients was that it gave a longer
| lasting steadier dosage than Ritalin LA. If a patient didn't need
| this advantage, they could just take Ritalin LA instead. This was
| used as a pretence to deny insurance coverage for Concerta
| because a generic existed and caused many insured patients to pay
| thousands of dollars out of pocket for the real deal which they
| never saw again. These generics were scams which hurt patients
| quality of life and the medical system was complicit in hurting
| patients while financially benefiting these fraudsters since only
| having to pay for fake medicine instead of real medicine saved
| them money. Nobody besides patients were punished.
|
| This was well known and well documented within ADHD circles and
| after some years led to two generics being decertified.
| https://chadd.org/attention-article/exactly-like-brand/
| https://www.goodrx.com/concerta/certain-generics-are-no-long...
|
| The problems with Concerta generics happened around the same time
| as the problems with Wellbutrin generics, problems which the FDA
| ALSO denied for years before backpedalling. The whole "generics
| are the same as the brand name" dogma is not actually true for
| all medications, and it's ADHD patients historically who were one
| of the groups of patients who found this out for themselves.
|
| So if people suspect there is a problem with their Adderall
| generics, I am VERY inclined to believe them, because we know
| that patients using similar drugs have shown extreme sensitivity
| to differences in generic equivalents in the past, and we know
| the FDA has approved "Generic equivalents" that were anything but
| repeatedly in the past.
|
| If you are getting ADHD medications, you can request your doctor
| write "no substitutions" and a specific brand on your
| prescription. If you are having coverage denied for either the
| brand name or the generic medication of the brand name (the exact
| same medication but with a different name and lower price, rather
| than being an equivalent) you CAN often get your doctor to help
| you lobby your insurer to get a specific brand covered by
| claiming medical need.
|
| >This means that, theoretically, obtaining a generic form of
| Adderall from a different manufacturer could alter how you feel
| while on the medication. However, the differences between
| generics are so small that an overwhelming majority of patients
| wouldn't feel any change from their previous medication. "It's
| not supposed to have drastic differences," Dr. Dube said.
|
| What an absolutely fucking ignorant assertion given the history
| of ADHD patients being noted for their sensitivity to small
| differences between brand name medications and generic
| equivalents. What data did he use to come to the conclusion the
| "overwhelming majority" wouldn't feel any change and is he
| talking about the ADHD patient population or the general patient
| population? If he means the former he's wrong, if he means the
| latter he's being obtuse and misleading.
| viraptor wrote:
| > and it's ADHD patients historically who were one of the
| groups of patients who found this out for themselves.
|
| I guess the things that work with immediate changes are going
| up be easier to spot. But even then you don't often know the
| expected result with (for example) pain killers. On the other
| hand, if ritalin wouldn't work as usual, it would be really
| obvious to me within a couple hours.
| 1659447091 wrote:
| > What data did he use to come to the conclusion the
| "overwhelming majority" wouldn't feel any change and is he
| talking about the ADHD patient population or the general
| patient population?
|
| This was my thought as well. Im very sensitive to manufacturers
| and spent months bugging my pharmacist to tell me which "brand"
| they had in stock so I could pick the one with least side-
| effects. Even though they had a note in my file they would just
| give me whatever they felt like and told me there was no
| difference.
|
| It took a different pharmacist who was also sensitive to
| understand my problem - to the point she chased me down this
| month after paying to tell me that it was a new manufacturer
| she hadn't seen filled for me and wanted to double check I
| wanted it before leaving the store. With the shortage I didnt
| care & was why she filled it before checking since it was all
| they had and would run out if she waited. And, it's not great,
| it's weaker which causes me to get tired (small doses put me to
| sleep), and starts to dissolve instantly so it will sometimes
| stick if I dont drink fast enough.
|
| I think that is one of the biggest problems. If people think
| they should all work the same and then get worse side effects
| they think its a fake, but it's probably just a different
| manufacturer that they have no idea to even check.
|
| For those that do, they dont seem to consider they are
| sensitive to the change. The best manufacturer for me is
| Camber, it's the only one that has no side-effects and "just
| works". The first few days I thought it was a sugar pill until
| I realized just how much I got done without even noticing. But
| do a quick search and people are outraged at getting switched
| to them and trying to get the FDA to revoke it.
| taylorportman wrote:
| I know this is overly tangential, sorry.. there are xr mechanisms
| with varying degrees of linearity, molecular 'handednesses', and
| recently I wanted to try these eye drops to replace reading
| glasses and stumbled onto this fractional dosage relationship.
| The last defined a medication's application - that generics vs
| expensive effects depend on customized level of active components
| that can produce a completely different drug. The point being
| that the discount of bulk medication and fine tuning make for the
| expense and it is still a compromise.
|
| The epiphany for me was those eye drops for reading would be so
| cheap if I could get it in bulk maximal strength and dilute to
| arrive at a specific concentration that changed a drug already
| used for completely unrelated (dry mouth or something) purposes
| at a slight difference in concentration apparently changes the
| fluid level in the eyes enough to compensate for age. I recalled
| all of the times a helpful pharmacist would change other types of
| prescriptions to avoid the expense of brand label fractional
| doses letting the patient substitute a common bulk variety and a
| pill cutter which becomes more difficult with fine granularity -
| this active ingredient/filler ratio for pills.
|
| So I began to wonder what do they do when manufacturing processes
| produce more desirable chiralities - what happens to the
| remainder?
|
| If there is some conspiracy it is probably related to
| manufacturing processes, bulk availability, and/or capacity for a
| pharmacy to behave like a custom apothecary, all of the liability
| that that would entail.. thus the expense of name brand
| pharmaceuticals?
| BizarreByte wrote:
| I'm glad there's no obvious shortage in Canada, this stuff has a
| tendency to spill over from America. I finally I was to get
| prescribed and it definitely works for me. 20mg of Sandoz XR,
| it's like magic.
| thomastjeffery wrote:
| The shortage is entirely arbitrary, and only exists in the US.
|
| We had a significant increase in ADHD diagnosis during the
| pandemic, because telehealth is much more approachable for
| people with untreated ADHD.
|
| Despite that increase, the DEA refused to increase the
| arbitrary limit for how much Adderall can be manufactured in
| the US. So we have an entirely avoidable shortage on our hands.
| trafficante wrote:
| > We had a significant increase in ADHD diagnosis during the
| pandemic, because telehealth is much more approachable for
| people with untreated ADHD.
|
| And, in typical fashion, the DEA responds to the problem in
| nearly the worst way possible: they announced new regulations
| to stop telehealth providers from writing new prescriptions
| for ADHD meds. I suppose this keeps the shortage from getting
| worse, but that's about it.
| dragonwriter wrote:
| They aren't new regulations, its the ending of the
| temporary suspension of the old regulations which was
| premised on the pandemic state of emergency, which has
| ended.
|
| Its bad because the pre-existing rules were bad and should
| have been changed instead of merely suspended based on the
| pandemic.
| briHass wrote:
| You may have just gotten lucky. It seems like the situation in
| the US is highly location/pharmacy-specific. The other
| variables are type (IR/XR, generic/non, etc.) and unit dosage.
| The worst hit seem to be 10mg/20mg generic IR Adderall, because
| that is usually the most popular and cheapest option. Switching
| to XR or to a less-common unit size (like 25mg) may increase
| the odds of finding it somewhere.
|
| It really is a super frustrating situation. Because of the
| tight controls on the drug, prescriptions are almost always
| sent electronically from provider to pharmacy, and any changes
| or transfers must go through the provider. Most providers
| aren't going to play whack-a-mole by continuing to transfer the
| script, and as the article implies, changing medication type
| (Ritalin/Adderall/Vyvanse) or IR/XR can have significant impact
| on the effectiveness and potential side-effects. Responsible
| providers aren't just going to flip/flop medications without at
| least a consultation.
| philwelch wrote:
| https://archive.ph/LIlpt
| analyte123 wrote:
| Kind of bizarre that the author won't entertain the most obvious
| explanation given the documented problems with many generic drugs
| [1]. I guess the difference in this case is that the patients can
| tell right away.
|
| [1] https://www.npr.org/sections/health-
| shots/2019/05/12/7222165...
| suzzer99 wrote:
| I've been on 4 different brands of generic Ritalin. I'm sure I
| can tell them apart by taking one.
|
| 1. Normal (the first one - don't remember the manufacturer -
| was extremely hard to break in half)
|
| 2. Actavis - strong, but slow to hit
|
| 3. KVK - strong and hits fast
|
| 4. Mallinkrodt - weak
|
| For years Mallinkrodt was the only brand my drug store would
| get. Now they switched back to KVK and it's like night and day.
| I only have to do half as much.
| brianjking wrote:
| The brand name worked significantly better when I took seizure
| medication with fewer side effects. The differences between the
| brand name and generic medications were very pronounced.
| Waterluvian wrote:
| The difference in Concerta and its generic is chocolate and
| vanilla to me.
|
| The brand one slow releases very evenly while the generic just
| slams me with the calm, focused joy followed by a significant
| emotional low for hours.
|
| Completely unsurprised if an Adderall generic had just as
| significant impacts.
| luckydata wrote:
| the generic concerta all have a KNOWN issue with
| manufacturing. The slow release mechanism is mechanic, not
| chemical, and only ONE generic is manufactured the right way.
|
| https://www.goodrx.com/concerta/certain-generics-are-no-
| long...
| [deleted]
| RyJones wrote:
| That is exactly my experience. The brand-name Concerta is a
| smooth push all day, the generic is terrible.
| guluarte wrote:
| same, generic vs concerta fells very different, the generic
| fills like a bomb while concerta it's slow and steady.
| mtlmtlmtlmtl wrote:
| People still use Adderall? America is a strange place indeed.
| Most of the world has moved on to dextroamphetamine a long time
| ago.
| philwelch wrote:
| Hush! Shh! Don't tell them!
|
| The adderall shortage is the result of a completely artificial
| quota set by the DEA. Those of us who use dexedrine have been
| mostly spared, but if the adderall users switch to dexedrine,
| we might start having issues.
| thomastjeffery wrote:
| Considering that the Adderall shortage has affected my
| pharmacy's supply of Concerta, you are probably just
| relatively lucky.
| WalterSear wrote:
| I had to go with amphetamine because dexedrine was
| unavailable in my area.
| waboremo wrote:
| Adderall contains dextroamphetamine btw
| mtlmtlmtlmtl wrote:
| I know this. But it also contains levoamphetamine.
|
| But as far as I know there's no clinically proven
| benefit(happy to be proven wrong) to including levoamph, and
| it can cause more side effects. Which is why in most
| countries these days adderall is not really prescribed, and
| often isn't even in the pharmacopoeia.
|
| Why adderall is still in use in the US is an interesting
| question I don't have the answer to.
| waboremo wrote:
| Do you have relevant sources about most countries refusing
| to prescribe adderall in cases where they do not also ban
| the use of dextroamphetamine?
| mtlmtlmtlmtl wrote:
| It seems to me Adderall is not even marketed in Europe.
| Can't find anything suggesting otherwise, but it's hard
| to find a source on something never happening.
|
| Though I can tell you definitely at least that here in
| Norway, Adderall is not an approved drug(neither is
| dexedrine). The only approved amphetamine here is Vyvanse
| and its generic form Aduvanz.
| loeg wrote:
| > But as far as I know there's no clinically proven benefit
|
| My impression of US pharma regulation and drug trials is
| that it would not have been approved if it did not show
| some benefit over the status quo. I don't know about
| adderall's clinical trials in particular, though.
| philwelch wrote:
| Adderall was originally formulated and marketed as a diet
| drug. It had already been approved before it was
| rebranded and remarketed for ADHD, and the criteria for
| approving a new on-label use is significant but not as
| rigorous as approving a new drug.
|
| Drugs that are still under a patent have a company with
| the incentive to go through the expensive approval
| process while generic drugs lack that. So a wacky mix of
| amphetamines designed as a diet drug that are still under
| patent have more corporate backing for that approval
| process than plain old generic dextroamphetamine, which
| has been around forever. There's a similar story with the
| use of esketamine versus ketamine to treat depression.
| loeg wrote:
| Ah, thanks for elaborating on the history.
| mtlmtlmtlmtl wrote:
| I was a little unclear maybe. What I meant was that
| there's no clinically proven benefit of racemic
| amphetamine versus dextroamphetamine.
|
| Racemic amphetamine is certainly an effective treatment,
| that's been well proven.
| loeg wrote:
| By "status quo," I meant dextroamphetamine.
| mtlmtlmtlmtl wrote:
| Oh I see, my bad!
|
| I think I was still in the mindset of thinking adderall
| pre-existed dexedrine. So I guess I interpreted status
| quo as meaning amphetamine vs whatever else was available
| at the time.
|
| Interesting little inversion of logic that can happen
| when two people have diametrically opposed ideas of the
| order of events.
| loeg wrote:
| Hah, no worries.
| at-w wrote:
| There is at least some evidence that levoamphetamine is
| more effective than dextroamphetamine for "hyperactivity
| and aggressiveness" associated with ADHD
| (https://jamanetwork.com/journals/jamapsychiatry/article-
| abst...), and other studies that have found that it has
| less of certain side effects than dextroamphetamine (though
| more of others).
|
| A more cynical explanation is that where levoamphetamine
| and dextroamphetamine alone were not patentable, a new
| combination of the two (as Adderall is) was patentable,
| making it more profitable to research.
|
| ADHD is a collection of symptoms that differ enough across
| individuals that it's almost certain some patients
| genuinely do respond better to different combinations of
| drugs.
| mtlmtlmtlmtl wrote:
| Interesting research, thank you. Though worth pointing
| out this study is comparing pure l-amph with pure d-amph.
| I'm not aware of enantiomerically pure l-amph being used
| clinically, which is an interesting side note: why not?
|
| Are you aware of studies comparing adderall specifically
| to d-amph? This has certainly piqued my curiosity.
| salawat wrote:
| This actually tracks in my experience. I did Vyvanse for
| a while but had markedly higher issues with aggression
| and agitation.
|
| Switched back to Adderall and returned to having near
| zero issues in terms of problematic aggression. Sample
| size 1 in my case.
| loeg wrote:
| Adderall is a mix of four amphetamine salts, of which dex is
| one. My impression is people went to dex because it was
| available as a cheap generic before Adderall's patent expired.
| But you can get generic Adderall now because the patent expired
| (cue: Vyvanse), so there isn't much of a cost reason to go on
| dex.
| at-w wrote:
| My impression was that dextroamphetamine also worked better
| in many patients than drugs that combine it with
| levoamphetamine such as Adderall. Even when Vyvanse was under
| patent and expensive, it was preferred by many for this
| reason (Vyvanse is converted into dextroamphetamine in the
| body). Levoamphetamine primarily acts on the norepinephrine
| system, while Dextroamphetamine acts primarily on dopamine,
| being 3-4 times as strong as Levoamphetamine in that sense
| (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670101/). As a
| result, many patients find levoamphetamine to cause much more
| physical side effects like racing heart, jitteriness, etc.
| and be less effective at promoting mental focus than
| Dextroamphetamine.
|
| Adderall is still 75% Dextroamphetamine, but I haven't seen
| much literature on why it would be preferred over drugs like
| Vyvanse that include no Levoamphetamine.
| mtlmtlmtlmtl wrote:
| I was getting increasingly confused so I just looked up the
| history.
|
| Adderall was invented to renew the approval of a weight loss
| drug which contained two salts each of methamphetamine and
| amphetamine. They replaced the methsalts with 2 more
| amphetamine salts, for some reason. That's why the 4 salts.
| Adderall was introduced in 1997, which suprised me. I always
| assumed adderall was first because surely it would be easier
| to synthesize than enantiomerically pure d-amph.
|
| But apparently Dexedrine has been around as a treatment for
| narcolepsy and attention problems since 1937.
|
| So it's not so much that the world moved on to dex, more that
| the US moved on to adderall for historical reasons having to
| do with pharmaceutical patents, approval and marketing. And
| the rest of the world were just fine staying with dex, which
| makes perfect sense to me.
| gtop3 wrote:
| > I always assumed adderall was first because surely it
| would be easier to synthesize than enantiomerically pure
| d-amph.
|
| I am not a chemist/pharmacist, but I am under the
| impression that amphetamine synthesis is neither
| complicated nor recent. I am under this impression because
| a) References to different amphetamines are common place as
| early as the 40s and b) The United States has a rich
| criminal history of amateur methamphetamine production.
| loeg wrote:
| Amphetamines were extremely common during and after WW2,
| for example.
| jebronie wrote:
| Lol, america is addicted. Take your meds, junkies.
| sourcecodeplz wrote:
| Don't be ignorant. There are many people living normal lives
| due to these medications whom would otherwise not be able to
| function. I do wonder though how did people deal with these
| problems in the past when neither ADHD or these drugs were
| recognized and available.
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