> No one doubts ADHD stimulants’ potential for abuse and addiction. Adderall’s active ingredient is amphetamine, a drug that functions in some ways like cocaine. Both deliver excess dopamine to the brain, enhancing motivation and concentration, and the cocainelike effect of stimulants is enhanced when they’re snorted. Hence the long-standing nickname for Concerta and Ritalin: Diet Coke. “There is a fear that the overuse of prescribed amphetamines could lead to the equivalent of another opioid epidemic,” said Dr. Joshua Sharfstein, who served as the FDA’s principal deputy commissioner under Barack Obama.
Concerta and Ritalin contain methylphenidate, not amphetamine. This is correctly stated elsewhere in the article, so I don't know why they're conflated here.
> In one of these rooms, Ascent’s founder and CEO — Sudhakar Vidiyala, Meghana’s father — points to a hulking unit that he says is worth $1.5 million. It’s used to produce time-release Concerta tablets with three colored layers, each dispensing the drug’s active ingredient at a different point in the tablet’s journey through the body.
Sort of; see "System Components and Performance" in [0]. There's an overcoat which contains an initial dose of methylphenidate that dissolves quickly. Under that, a three-layer core: two drug layers and one pump layer for an osmotic-controlled delivery system [1]. As the pill is processed through the body and into the gut, water is absorbed into the pump layer through a semipermeable membrane which causes the pump layer to gradually expand, pushing methylphenidate from the two drug layers out through a laser-drilled hole over time. It's a cool little mechanism.
Kind of like "opioid" includes natural opioids (heroin), semisynthetic (oxycodone) and fully synthetic (fentanyl/analogues) all with different pharmacology it's reasonable to lump in the "releasers" (amphetamines) with the "reuptake inhibitors" (alkyl phenidates, cocaine etc)
I mean that ship has already sailed in the form of the "methamphetamine epidemic" but just to be pedantic
You're just reading a mildly ambiguous sentence in poor faith. Not only is the amphetamine comment clearly applying to Adderall—which is true—methylphenidate also delivers an uptick in dopamine, which is why it's effective at all. The difference between the two drugs—which is meaningful in many contexts—is not substantial in this context.
> You're just reading a mildly ambiguous sentence in poor
faith. Not only is the amphetamine comment clearly applying
to Adderall—which is true—methylphenidate also delivers an
uptick in dopamine, which is why it's effective at all. The
difference between the two drugs—which is meaningful in
many contexts—is not substantial in this context.
I disagree. The OP is correct in calling out the bogus languge used in the article.
Saying the difference between Adderall (an amphetamine) and Ritalin (methylphenidate) doesn't matter because they both just boost dopamine is like saying it doesn't matter whether you turn up the volume on your speaker by using a remote or by walking over and pressing a button. Yes, both methods make the music louder, but how they do it is different.
Adderall pushes more dopamine out, while Ritalin makes sure the dopamine that's already there sticks around longer. This matters because, depending on someone's unique brain chemistry and health, one method might be better for them than the other. It's not just about the end result (more dopamine); it's about how you get there and what side effects might come along for the ride. Just like some people prefer the remote for convenience, doctors and patients might prefer one medication over the other based on how well it works for them and how it makes them feel.
> Saying the difference between Adderall (an amphetamine) and Ritalin (methylphenidate) doesn't matter because they both just boost dopamine is like saying it doesn't matter whether you turn up the volume on your speaker by using a remote or by walking over and pressing a button. Yes, both methods make the music louder, but how they do it is different.
Ok, but considering the context your distinction has no relevance.
The author was clearly sweet-talked by the company lawyers and PR people. It's so pandering in places it's embarrassing. If a company manufacturing amphetamine is discovered to have been keeping two sets of books I'd want them investigated pretty vigorously, especially considering the ongoing human hellscape of the opioid epidemic.
You can keep operations going while still investigating the company. Imagine if Marathon Oil was discovered to be smuggling crude oil from Russia into their refineries and splitting the difference with Putin so Russia could bypass international sanctions, and an agency completely shut down Galveston Bay and Garyville (the two largest oil refineries in the US) in response - as soon as the news hit, prices for gasoline, propane, LNG, new plastics, etc. would go through the roof and runs on gas stations would begin. The public outrage would be swift and Congress would force whoever shut them down to let them resume operations while the case was underway.
There's no such sympathy for people unable to function without their meds, sadly.
This. And this is tempered response is generally considered a mark of a good journalist. Someone who sees the whole picture. I can't call the journalist here (James D. Walsh) a good journalist though, because I personally don't know the track record. What's hard is that it is difficult to distinguish these two concepts of pandering or tempering. A track record is really all there is.
There's never a smoking gun. And this should be the big takeaway for a lot of people: if you're looking for smoking guns you'll find them everywhere. But if you're looking for killers, they hide in the shadows. Sure, there are some where you do clearly see them standing over the body in clear daylight with the smoking gun in hand and the dead still warm. But that is far more rare. The best way for these people to hide in the shadows is to make it difficult to distinguish good and bad. To create the shadows and fog. The reason this is often easy is because the good and right actions are nuanced and considerate of complexity.
Like truth and lies, truth has a lower bound in complexity but lies do not, they can be infinitely simple. We humans love simplicity and that's what they exploit. It's unfortunate but if everything was half as simple as we pretend they are, we wouldn't have 90% of the problems that exist in the world. We live in a complex world and humans have been solving problems for thousands of years, it's pretty reasonable that the vast majority of simple issues have been solved. So if you want truth, be wary of simplicity.
adderall use is pretty widespread in the media industry, a lot of journalists seem to think it's great stuff and find the shortage annoying. i think there's likely some natural sympathy here too.
> i think there's likely some natural sympathy here too.
If you take a look at the comments on this thread I think you'll see there's also a whole group of people who don't use the medication but have quite strong feelings about whether or not it should be used, why it's used, whether or not life is fair because people use it, etc.
Wouldn't be much of a stretch to infer that the author could also be in that camp.
No one said anything about keeping two sets of books. The issue is some stupid DEA form. And I don't think the DEA should even exist. So I am 100% on the company's side.
Here is how stupid some of these DEA regulations are:
> But the company has acknowledged that it committed infractions. For example, orders struck from 222s must be crossed out with a line and the word cancel written next to them. Investigators found two instances in which Ascent employees had drawn the line but failed to write the word.
No, in fact you're quite wrong there. It's a hotly debated topic with sufficient numbers, and respectability of protagonists, on the side that questions dyslexia for it to be wholly inaccurate to refer to it as a fringe belief. Of course there is real variation in people's abilities to read and perform other cognitive tasks. But the idea that a clearly diagnosable, discrete medical condition can be identified has substantial opposition within the community of experts in the relevant subjects.
It's fairly obvious that terms such as "ADHD" and "dyslexia" are just referring to regions within a multidimensional space of cognitive abilities and psychological characteristics, and that it's misleading for the medical/psychological community to encourage people to think that they "have" dyslexia or "have" ADHD, almost as if they're talking about "having" a malarial infection or a broken leg.
Theres an overwhelming amount of educational and psychological research that supports the existence of dyslexia as a specific learning difficulty that affects reading. It’s recognized by reputable medical, psychological, and educational organizations worldwide. Disbelief in dyslexia goes against well-established scientific evidence and consensus. The existence of a handful of books and articles and papers to the contrary doesn't do much for the notion that it's on the fringe. Flat Earthers have plenty of books.
Perhaps my accusations are more against the set of humans that in practice are diagnosed with dyslexia, than against the existence of a set of humans that in theory it would be reasonable to diagnose with dyslexia. But what happens in practice is, sort of important.
What are the good reasons? I see lots of opinion in this comment but very little in terms of substantiated arguments for the genuine scientific questions you mention, even more in the case of dyslexia which has broad scientific support.
I didn't take it as inflammatory but simply as a "it's true because I said so" type of comment, I'd gladly accept to see some reputable sources supporting your argument.
I think there are at least two major threads to this, both important:
(1) Is there meaningfully distinct and circumscribable medical condition that is diagnosable and merits its own name, and merits people being told they "have X", in the same way as they "have" a viral infection.
(2) If there is, then is the set of people in practice diagnosed with X in society anything close to the "correct" set of people under (1)?
(1) is controversial, and even if (1) is true, the answer to (2) is clearly "no". So even if you believe in (1) then in practice, as a phenomenon of our society, it is nonsense: a large proportion of those diagnosed believing incorrectly that they "have" a certain medical condition.
Another way of asking it is: clearly humans vary along cognitive/psychological dimensions. What exactly would make you say "Oh, there's a disease", rather than "Oh, there's variation"?
Are you at least in agreement that large areas of modern medical psychology / psychiatry are bullshit? Diagnosing people with "sex addiction" and stuff like that? Presumably you are. That makes it a bit easier to see how society can have slid into the mistake it's made with "ADHD" and "Dyslexia".
I believe I agree with your arguments, at least in the case of ADHD it's only a "disorder" due to the expectations of society on productivity, consistency, etc., as an individual if I didn't have societal pressures on my output (both at work as in home chores, etc.) I'd say I wouldn't be impacted at all by living with this. Actually the opposite, there are some benefits I get from living with ADHD, the main issue is living with it in a society that expects a very different functioning than what I'm naturally inclined to.
How do you propose that? Afaik, everyone who has access to it has a prescription for it. And the predicate for having a prescription is a diagnosis. On paper, everyone genuinely needs it.
(I said "genuinely" to distinguish from "on paper".) I don't know how to execute on reducing the juicing use of these meds. One idea is to start going after pill-mill doctors, like for opioids?
What if we had cognitive performance enhancers that were deleterious to your health? Let's say they made you twice as smart but cut your lifespan in half. You might not choose to take them. But others would. And now you find yourself functionally retarded compared to those people. Think about how many advantages they get in hiring and personal success for their Faustian bargain. You might just cave and start doing them yourself. And then say even more powerful ones come along -- these make you four times as smart but are even worse for your body. Everyone just game theoretically spirals into the most extreme Faustian bargains.
That's a dystopian concept I've never seen explored anywhere.
Except sports, where the government steps in and makes sure that doesn't happen. ;)
As someone who’s been on this stuff for most their life… You aren’t doubling your intellect with Adderall. In fact most tests show that neurotypical people taking stimulants only see a moderate (a couple points on the test) increase. The drug has diminishing returns.
As someone who hasn't been on them for nearly that long, I'll also validate this. I wouldn't say it even makes me smarter in any way. Possibly less so. But what it does is stops my brain from constantly pinging me about things that don't need to be addressed at the moment. It really changed my ability to do work and succeed because I went from everything being an emergency triage hell (from making the bed to the report due in an hour) to actually being able to triage issues.
I can also confirm the diminishing returns and will even state that if I take instant dosages around what people say they do, I'm highly non-productive again. Finding the right dosage level and schedule is still a challenge and varies day to day. There's far too common a myth that you just pop 20mg of Adderall and you can focus for 10hrs straight. Maybe that's true for some people, or maybe even for just people without ADHD, but certainly not true for me. For me it is just like turning down the volume on an alarm.
Considering those with ADHD have a life-expectancy that's 13 years shorter than someone without it [1], I'll take whatever mild neurotoxicity you're pointing out in exchange for being less likely to get into a car accident or whatever else I have a tendency to do.
That is not true. All studies have shown they are only neurotoxic if abused and by abused I mean taking nearly 10x of a normal dose. At that level
Of abuse anything is neurotoxic.
>Adderall may have neurotoxic effects in doses higher than the recommended therapeutic dose; however, it may also potentially be neurotoxic in prolonged regular doses over a long period of time.
There is a lot of recent research on this and it does not agree with you.
I'd say it does agree with OP considering the article used "may" and is followed up by "Currently, there is not enough scientific evidence to support Adderall’s neurotoxicity. Additional research on the effects of prolonged stimulant use is necessary.
I believe OP was saying that neurotoxicity has only been definitively shown in higher doses. Granted I highly doubt no studies show neurotoxicity at lower doses, but it doesn't look to be a settled matter.
>Amphetamine Treatment Similar to That Used in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder Damages Dopaminergic Nerve Endings in the Striatum of Adult Nonhuman Primates
Also, a lot of people with mental health issues can survive without their medication, it can significantly decrease their quality of life or ability to function.
I can survive without my ADHD being treated but I can't work. Fortunately for me, I am on a different type of medication so this shortage doesn't affect me, but I can see what's happening to my coworkers. My team is going to lose people due to this bullshit.
This right here. I'm prescribed Adderall off-label for excessive daytime sleepiness, and have been for over a decade. I have tried multiple times to come off of it because of my concerns with long term effects (especially with my heart).
Can I survive? Absolutely. But without it, I am a zombie; a complete shell of myself. Even with concerns over long term side effects, the tradeoff isn't worth it for me.
That some "work" requires lifelong consumption of a stimulant with a fragile supply chain maybe reflects a deeper problem than any shortage itself.
Why are your coworkers so committed to this work if it suits them so poorly? Are they really unable to perform any work without a drug?
It's a little wild that people would sooner see themselves as "ill" and in need of $xx/mo of side effects and shortages for the rest of their lives than think that maybe the expectations they've put on themselves aren't right.
Maybe the work is not a good suit for them. Maybe their lives are structured poorly. Maybe your whole industry or social class is broken and is demanding more from people than they can deliver without drugs. A shortage is a really good opportunity to look more closely at those possibilities, especially the last one.
This sounds like something I would have said before living with someone with ADHD.
It would take a long time to explain adequately. But to summarize, neurodivergence can be a pervasive, debilitating problem for people, and medication is in many ways a miracle cure. And the solutions you suggest require the exact type of executive function that sufferers are lacking.
Of course it would be nice to wave a wand and change society instead, but that's not going to happen.
Agreed. You really have to experience or see something to truly understand it. Recently, every time I’ve had a serious medical issue, I’ve learned how people who are permanently disabled live.
You are conflating ADHD as something strictly affecting work. It does not only affect work, it affects your whole life.
You wake up and need to make your bed, but then you also have to take a shower, and brush your teeth, there's also laundry to do, and coffee. Maybe breakfast if you are hungry, but there's also mail to pick up, and emails to read, and plants to water, you also need to schedule a thing after work, and there's also a message from your parents to reply.
All of those things are ringing out loud "I need to be done" at the same time, with the same priority, you know you should just start with one thing but you can't, you simply can't, the other things are like loud alarms going in your head to not be forgotten. You feel overwhelmed, you take a shower. One thing done, you make coffee, you drink it and feel you need to go for a walk to clear your head, you come back home and drink a bit more coffee, oh, but I forgot to brush my teeth when I was in the bathroom, and now I know I shouldn't brush right after drinking coffee, you wait a little bit for the sake of your teeth, you forget about it again.
You go through your day, you remember you forgot to pick up the mail, you go to pick up the mail, you see your front yard a bit disorganised, you start putting things in place, you go back inside the house and remember you forgot to pick up the mail.
You don't make breakfast because many distractions took your time, you start working, you force yourself to focus, you do the work even though other things ring in your head all the time, you finish work and now you're exhausted.
You do other day-to-day things, you cook, etc., time for bed, now you remember all the things you forgot to do: you didn't do laundry, you forgot to reply your parents' message, you forgot that you booked an appointment for tomorrow morning. Oh, you also forgot laundry, for the 2nd week in a row, you do it because tomorrow you won't have clothes, so the urgency makes you focus and prioritise it.
It's a constant, never-ending stream of remembering, forgetting, overcommitting, self-guilty, no matter what kind of organisation ritual/system you try you eventually fail, each failure feeds back into the guilty, into the shame.
And it's constant, every single day of your life, in every single activity you do. In conversations, at work, doing daily chores, everything takes a lot of effort to be focused, to do what you are supposed to do.
So maybe life isn't for me, should I just off myself?
The world also existed before capitalism and office jobs, when people who were nuerodivergent could still reliably contribute to society and their talents even be beneficial. We now have a system where those who can focus the longest and grind the hardest are the ones rewarded. Anyone else is either mediocre or worse, at risk of being able to provide for themselves because no other method of work is considered nearly as valuable.
Most well-"rewarded" people I've known are not acclaimed for their focus or for their long hours.
Some figures highly esteemed for their talent are noted for extreme focus and diligence, but rarely are these people especially well rewarded with money or comfort. They just get pointed at and receive some "oohs" and "ahhs" while feeling pretty alienated and seeming pretty unbalanced. It's not something most feel themselves aspiring to and it's definitely not what society has set itself up to reward.
Society seems to reward people who get about as much done as they say they can, consistently, on something useful, while not being too unpleasant to be around.
There's plenty of room for neurodivergent people in that society, even without stimuants.
> Society seems to reward people who get about as much done as they say they can, consistently, on something useful, while not being too unpleasant to be around.
You said yourself, consistently. There's nothing consistent about living with ADHD, you simply can't be consistent, it's one of the major issues with it.
I believe you are speaking out of ignorance, and that's fine, if you also allow yourself to know you are ignorant and try to understand how it is for others, to grow out of your own ignorance.
If you have not lived with ADHD or had a partner with it to understand the many, multifaceted ways it affects someone's life I don't think you can even grasp what it is, it's ok to be ignorant if you are kind enough to acknowledge and try to understand what you do not know about.
So far I've only seen your rebuttals coming from the same place as people telling us we should just do better, that is a simple matter of willpower. Or worse, that society does accommodate for it (it doesn't).
Society rewards consistency, rewards people with good organisational skills who can persist on a task until its completion, no matter how boring or difficult it is. A neurodivergent person has to develop and practice that, every single day, knowing that in many days you'll fail to do it and all that's left is to try again the next day, and the next, and the next, and the next...
I can honestly say that I wouldn't have been able to hold down a serious professional career without it - ADHD is a very real thing that some people have to deal with, and its effects can be crippling to life outcomes.
I don't like the way stimulant medications feel to actually take, and the long-term health effects do worry me a bit, but it makes it possible for me to live something significantly closer to a normal life than I would ever be able to manage without them. Really can't overstate how transformational it's been for me.
Ditto, 100% same story. I kinda knew I had ADHD and was able to investigate some childhood stuff that suddenly made more sense, but I waited until I had a crisis that was compromising my ability to function at work before finally talking to a shrink. Wish I'd done so a lot sooner.
I can start/stop, take drug holidays, etc. with amphetamine (adderall in my case) at will with no ill effects. Caffeine on the other hard, is brutally unpleasant to miss a day of. Been on the same dose of adderall for a few years now. I was able to reduce my caffeine intake significantly after starting adderall.
We're not unaware though. We know we are capable of doing these things because we can do them exceptionally well in short bursts of hyper-focus. We see the potential and we desire the outcomes. We lack the executive function to put those things into action consistently.
I was not completely unaware of failing most classes in high school and having to get a GED despite wanting to do my homework and study for tests. I was very motivated and interested in the subjects, I could just not focus enough to complete my work. This caused me to have an adverse reaction to even starting a project/task which I still struggle with today (even though it's much easier now).
So while I can of course not predict what would have happened, I can pretty safely say my life path would have been completely different had I had a chance to get treated earlier. I would have gone to college, at least.
> I was not completely unaware of failing most classes in high school and having to get a GED despite wanting to do my homework and study for tests.
This was pretty much me as well. I remember at the start of every new school year promising this time it would be different. I would do my homework and pay attention in classes and get good grades! Each year it spiraled into the same mess. Diagnosed with ADHD in my 30's.
My point is that you're ginning up a scenario in your head that wasn't ever going to happen, and you're doing it so that you can feel bad about things for a little bit because feeling bad is nostalgic. You don't really need loose ideas like that rolling around your head when you're taking these meds. That was your old life.
>My point is that you're ginning up a scenario in your head that wasn't ever going to happen
Do you mean that if I had been able to treat my disorder earlier, nothing would have been different? I don't dwell on it, but to say my academic success would have been wildly different medicated is just wrong.
Yes, it does help with working memory. I'm not sure if it adds a slot, or makes it harder for other items to sneak into the limited slots, but it helps.
It gives me some control over my focus, leverage against the executive dysfunction, and the choice to not chase dopamine.
For me it definitely does, it seems like my brain is able to fit more into its "main memory" while focused on a task, whereas without it it seems like I'm "swapping to disk" to put it into computer terms.
I don't take it on the weekends, and I feel a huge difference in my ability to remember what I'm working on around the house.
Parents never saw there was an issue. I was mostly "normal" until I started seeing symptoms pop up in the 5th grade. Don't have a guidance counselor but I should probably just ask my dad.
My parents were against it too, even though my 5th and 6th grade teachers both suggested it. Then in High school my guidance counselors highly recommended I get tested.
There was definitely a stigma for mental illness with the boomer generation, I suspect my mom did not want to be associated with a child that has a mental condition.
Concerta and Ritalin contain methylphenidate, not amphetamine. This is correctly stated elsewhere in the article, so I don't know why they're conflated here.
> In one of these rooms, Ascent’s founder and CEO — Sudhakar Vidiyala, Meghana’s father — points to a hulking unit that he says is worth $1.5 million. It’s used to produce time-release Concerta tablets with three colored layers, each dispensing the drug’s active ingredient at a different point in the tablet’s journey through the body.
Sort of; see "System Components and Performance" in [0]. There's an overcoat which contains an initial dose of methylphenidate that dissolves quickly. Under that, a three-layer core: two drug layers and one pump layer for an osmotic-controlled delivery system [1]. As the pill is processed through the body and into the gut, water is absorbed into the pump layer through a semipermeable membrane which causes the pump layer to gradually expand, pushing methylphenidate from the two drug layers out through a laser-drilled hole over time. It's a cool little mechanism.
[0] https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/02...
[1] https://en.wikipedia.org/wiki/Osmotic-controlled_release_ora...