[jkaplowitz]

None of those statements are generally true.

By far most legally prescribed ADHD meds are not methamphetamine, only some are even amphetamines at all, and they affect people with ADHD quite differently from neurotypical people.

Among people with ADHD the specific experience varies widely by person.

My personal experience using legally prescribed Adderall XR was so unpleasant that I can’t imagine voluntarily using it for recreational purposes or often enough for any purpose to end up addicted. It was more a question of “does this situation require me going through the downsides of taking it, and how do I make sure it helps more than it interferes.” There’s no way that’s what neurotypical recreational users experience.

My current ADHD treatment does not involve any amphetamines, and I’m completely fine with that.

(Why did I use “generally” in the first sentence of this comment? Legal prescription methamphetamine is technically available in the US and approved for ADHD treatment, under the brand name Desoxyn, but it’s very much not a common choice to say the least. All other options are vastly more commonly prescribed. For my own ADHD treatment I’ve never been prescribed meth, even though I’ve been prescribed most of the common ADHD meds over the years including several different amphetamines and multiple non-amphetamine options.)

[bun_terminator]

There is no such thing as "neurotypical"/"-divergent"

[jkaplowitz]

It's not conducive to a productive discussion to ignore the vast majority of what I wrote, including my entire substantive argument, while nitpicking on one point of terminology when the meaning I meant was clear from context.

If you want me to be explicit about this contextual meaning: since I was discussing the pharmacological differences for these medicines in people with vs without ADHD, "neurotypical" in this particular context simply has the contextually narrowed meaning of "without ADHD".

I didn't use the word neurodivergent in this conversation, so I won't address it in this comment, nor will I address the question of whether "neurotypical" is a useful word now that you definitely know what I actually meant.

My prior comments in this conversation are now outside of the edit window. So, in your brain, I encourage you to replace my phrases "neurotypical people" and "neurotypical recreational users" with "people without ADHD" and "recreational users without ADHD" respectively. Hopefully you agree that these are real categories of people, whether or not you like the word "neurotypical" to describe them.

Within that understanding of what I meant, I also encourage you to proceed to respond to the rest of what I said in a substantive and productive way. If you do that, I will happily respond substantively and productively in return.

But if I see any further non-substantive responses from you in this subthread, I will simply choose not to respond and will leave you with the last word, instead of spending even more of my my time on a non-substantive discussion than I have so far.

[AStonesThrow]

This is because pharmacology is a shell game, where there is a constant pipeline of new chemicals being rotated in as soon as they're "recognized as safe". That is because people start to notice the adverse, toxic effects of the "old and busted" chemicals, such as Thalidomide or Phen-Fen, aren't such the "miracle drugs" they were cracked up to be, so there needs to be a constant stream of new stuff to replace it. They simply need to approve drugs a bit faster than attorneys can file class-action lawsuits.

https://en.wikipedia.org/wiki/Fenfluramine/phentermine

Another effect is that the "new stuff" is a weak synthetic facsimile of whatever the previous drug generations were, and eventually you end up with 100% fake treatments, often doing the opposite, exacerbating and magnifying the very symptoms they're prescribed for, or damaging the target organs/glands, and shutting them down.

"Fail first" or "step therapy" policies by insurance carriers will aid and abet this behavior, as the prescribers are forced to begin with inexpensive and ineffective (or harmful) treatments before they can even propose a treatment that is deemed efficacious.

https://en.wikipedia.org/wiki/Step_therapy

So, yes, my comment about people high on amphetamines was relatively tongue-in-cheek, because physicians are seldom incentivized to get people high these days: they're incentivized to push the new hotness wonder-drugs that people haven't figured out are just as horrible as the old ones.

[jkaplowitz]

Nope. The two most common non-amphetamine ADHD drugs, methylphenidate and atomoxetine, are both now old enough that they’re available in generic form, and methylphenidate is cheap enough that step therapy is not routinely required before insurers cover it. Even one of the pretty new and therapeutically effective long-release amphetamines, Vyvanse/Elvanse, is now available as a generic as of (I think) summer 2023. So are most of the other amphetamines.

You’re right in general about how much of the pharma industry prefers to operate, but wrong about what’s true in the specific context of ADHD treatment, and also wrong (even if your remark was only tongue-in-cheek) about whether people with ADHD get high when they do take an amphetamine as prescribed.

That last misconception is actually quite harmful, whether or not you were joking. It’s a perverse fact that most of the obstacles which state and federal legislators, state and federal regulators, major pharmacy chains, and pharmacists put in the way of smooth access to most ADHD medications - primarily as part of the war on drugs - are uniquely hard to handle and overcome for people with ADHD, due to the types of life struggles that ADHD causes in particular.

The widespread stereotype of people with ADHD as drug seekers looking to get high, at least in much of the US, makes appropriate policy outcomes hard to achieve and hard to experience in practice. The benefit of medicines to people with ADHD is no less legitimate than the benefit of Ozempic or insulin to people with diabetes. And nobody with ADHD gets high from therapeutic doses of ADHD medicines.

Anyone who does get high from such doses doesn’t actually have ADHD, and so either they got the prescription from a doctor guilty of diagnostic medical malpractice (or a doctor complicit in a false diagnosis/prescription) or they lied to the doctor in a fraudulent way when undergoing the diagnostic process. Those are worth punishing, but not at the expense of making it unreasonably difficult for the medicines to be accessed by the very same population for which they are quite legitimately approved and prescribed.