[mithametacs]

I literally did the thing you’re not supposed to do.

my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her.

Then I just told my psychiatrist that I have Adderall prescription and she took it over.

For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Medication that actually works.

[mandevil]

The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it. This is a response to the problems with the abuse of legal opiates a decade ago- the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.

Your psychiatrist is trying to deal with the DEA monitoring, and doesn't want to be the one who first puts you on it, but continuing an existing Rx is not treated the same by the DEA, as I understand it. So the online doc is putting her license more at risk to a DEA investigation, but your in-person doctor is less exposed.

N.B. this is how I understand the things that my wife has said to me. She is actually a pharmacist who has to deal with these things, and I might have garbled something.

[lysp]

> The DEA put Adderall on its list of the most abused medication, and limits production of it and investigates doctors who prescribe too much of it.

The other thing on top of limiting its production, it's not just for the US, it's worldwide.

Australia has a shortage of various types of ADHD medication due to this DEA production limit too.

https://www.tga.gov.au/safety/shortages/information-about-ma...

Also, the Australian Government requested increased production to cover these shortages, and the DEA rejected that request.

So those limitations have a worldwide effect due to the US being one of only a few countries that produce these drugs.

[bawolff]

Is there something stopping other countries from spinning up a factory?

[graemep]

They have. It was originally made by a British company but is now out of patent and is made by multiple companies in multiple countries.

[unmole]

- Supply chains

- Skilled workforce

- Risk capital

- Regulatory overhead

[bawolff]

Other drugs are made outside the USA, what is so special about adderal (besides us regulations which other countries dont have to listen to)

[safety1st]

Probably that it's basically a weaker form of meth. I mean they're chemically similar, they have the same effects, adderall is potentially addictive, nobody wants to end up dealing with something similar to America's meth epidemic. That's not to say you can't manufacture and prescribe this drug safely, but a lot more people are going to have a lot more reservations about it than if you want to crank out a generic Tylenol or something.

[colechristensen]

Nothing is special about it. Lots of drug manufacturing is low-risk low-reward but setup costs are high so nobody thinks it's worth the investment.

[claudex]

Maybe it's just that the cost to set up the production elsewhere is too much for the expected market. The shortage of the drugs doesn't mean there will be enough buyer to cover the cost (and make enough profit).

[bratwurst3000]

the article is about methylphenydat (ritalin) and not adderall. Amphetamie is such an easy molekul, stepping up production should be super easy.

[chris_wot]

Trump wouldn't like it.

[chris_wot]

He has literally targeted Australia for our pharmaceuticals.

[tstrimple]

> the DEA now takes potential abuse of legal drugs much more seriously and adderall (an amphetamine- it's a cousin of meth) is at a high risk of abuse.

I know that I process Adderall differently having ADHD, but I still struggle to see how it's used recreationally. I took it somewhat consistently for over a year for ADHD treatment until I missed an appointment and couldn't get around to scheduling another before my prescription ran out. After that getting back on became more trouble than it was worth. Not once did I ever feel a high from Adderall. My best naps were on Adderall. Not once after dropping it did I ever feel withdrawals or the urge to take more. The only thing I felt while taking it was constant dry mouth and my brain no longer constantly jumped between topics outside of my control.

My brother abuses controlled substances. When I told him I was taking Adderall he warned me to be careful and talked about his issues with it and I just couldn't relate at all. I'm no stranger to addiction. I'm an alcoholic and am addicted to nicotine via fruity vapes. But Adderall? Nothing at all.

[adastra22]

My doc says the best diagnostic for whether you have ADHD is to prescribe Adderall and see what happens. Those with ADHD react very, VERY differently to the drug than the rest of the population.

[bratwurst3000]

i dont think thats true. I have ADHD and get amphetamine as medication. I gave it some friends and it had similiar effect as with me. they where hyper focused and aware. I think its what amphetamine does with every human. Regular humans have more focus and adhd people have suddenly focus but netherless same.

[adastra22]

Focus is the same. It's the euphoric high and increased hyperactivity in neurotypicals which is the divergent response.

[shlant]

the euphoric high also happens in those with ADHD but only when they first start taking it. I would assume if you took it recreationally and not consistently you would have the same effect

[bratwurst3000]

thats where i have to disagree. if I give anyone 5mg dexteoamphetamin they would be less hyperactive and more focused on one thing. If you do too much it doesnt matter if you are regular brain or not. 80mg of dextroamphetamin would make everyone look like a speed freak.

If it would make people hyperactive it wouldnt be used for learning and sitting there 16h hyperfocused.

IMHO

edit: to explain better. imagine a adhd brain having dopamin swings between -1 and +1. While there are those swings people cant execute their plans and cant focus on one goal. when you give them adderal or similar they get a powerboost to blasting +2 dopamin lvl and can keep that for hours.

so if you give a regular human beeing the same amount of adderall it will blast its brain on +2lvl dopamin also.

so adhd people and regular people behave the samw on adderall.

the thing with adhd it is not a lack of dopamin but an iregular flow of dopamin that is the problem. The solution is to hypercharge the brain with dopamin to get constant lvl.

[beaugunderson]

your doc is buying into a very pervasive myth, see e.g. https://journals.sagepub.com/doi/10.1177/070674370200601S07

[chipsrafferty]

I doubt that very much

[LoganDark]

> I still struggle to see how it's used recreationally.

- Adderall keeps you awake. Some people use that to be awake for very long periods of time. Long drives, marathons, etc.

- Adderall can make boring tasks seem engaging, so it can be used, for example, to help a student study. Combining that with no need to sleep that night, can become a bit of an unfair advantage.

- Adderall can cause a high, even though I've only ever experienced that with pure dextroamphetamine. For me it caused everything to feel warm and pleasurable somehow, the first couple weeks I was taking it.

Now I feel nothing except the wakefulness, although when I stop taking it for a while and then start taking it again, sometimes I will spontaneously do every chore that's been building up over the past months in a single day. That's just how it goes for me apparently.

[radu_floricica]

That's not recreationally. That's actually a good, useful drug effect (even if not specifically for ADHD).

I'm more than a little pissed that governments don't let us use drugs like this responsibly.

[Henchman21]

Governments treat their citizens like children to be watched over, not like adults capable of making decisions. Until that changes, expect to be pissed off.

[LoganDark]

> I'm more than a little pissed that governments don't let us use drugs like this responsibly.

I mean yes. Proper education and harm reduction is vastly superior to this "controlled substances" bullshit.

[adastra22]

> Adderall keeps you awake

For many (not all) ADHD'ers, amphetamine or caffeine makes them sleepy.

> Adderall can make boring tasks seem engaging

This is true

> so it can be used, for example, to help a student study ... can become a bit of an unfair advantage

Unfair? This isn't sports. Nobody is being cheated by a study-enhancing drug.

> Adderall can cause a high, even though I've only ever experienced that with pure dextroamphetamine. For me it caused everything to feel warm and pleasurable somehow, the first couple weeks I was taking it.

Interesting. FYI ADHD people feel none of that. If anything, the opposite: on stimulants ADHD people feel relaxed and normal, bringing them down from hyperactivity and allowing them to focus on their life.

[LoganDark]

> For many (not all) ADHD'ers, amphetamine or caffeine makes them sleepy.

You're right, I was mainly speaking about people without ADHD using stimulants.

> Unfair? This isn't sports. Nobody is being cheated by a study-enhancing drug.

No, but it can lead to bad health effects for the student, and bad habits like dependence.

> Interesting. FYI ADHD people feel none of that.

I guess my ADHD diagnosis must be mistaken then? And my executive dysfunction must come from somewhere else...

ADHD is not a single neurotype. As even the most basic example, multiple different expressions of autism can each have ADHD.

> on stimulants ADHD people feel relaxed and normal, bringing them down from hyperactivity and allowing them to focus on their life.

Stimulants still help me regulate my sleep cycle and focus, but I don't think I experience hyperactivity from not being on them. (anymore at least; when I was younger I almost couldn't sleep without melatonin. That resolved itself before I ever touched stimulants, though.)

--

I have heard of people with undiagnosed ADHD self-medicating with meth. Slightly different than people without ADHD using stimulants recreationally. I personally hope to never touch meth because I heard it can ruin one's relationship with other stimulants, and I don't want my medication to become any sort of recreational thing because I need to depend on it and not seek highs, but I feel like self-medication can be perfectly valid if someone knows what they are doing. Big if though.

[adastra22]

My blanket statement was perhaps too broad. There are less than 10% of ADHD people whom do not demonstrate the paradoxical response to stimulants. That said, the percentage of misdiagnosis is at least that high, which makes one wonder. Mild bipolar is often misdiagnosed as ADHD, for example, and often discovered exactly because stimulants don't work as expected.

I missed on first read that you said the stimulants only had that high for the first few weeks though. That sounds different from what I understand to be the neurotypical response.

> Stimulants still help me regulate my sleep cycle and focus, but I don't think I experience hyperactivity from not being on them.

You may have the distracted variation rather than hyperactive.

[shlant]

> Adderall can cause a high

> Interesting. FYI ADHD people feel none of that.

Please don't speak for a whole group of people when you don't know what you're talking about. Euphoria is very common when people with ADHD first start taking amphetamines, it just goes away after a week or so.

[hirvi74]

> Interesting. FYI ADHD people feel none of that. If anything, the opposite: on stimulants ADHD people feel relaxed and normal, bringing them down from hyperactivity and allowing them to focus on their life.

That is common myth. It's a matter of dosage over time. If one takes 120mg of Adderall in one go, then I can assure you they will not be calm nor relaxed. The relaxed feeling comes with a build of tolerance over time and with the lowest therapeutic dosage possible.

I won't deny that people with ADHD might perceive more benefits from stimulants than those without ADHD. I person with poor vision probably would perceive more benefit from eyeglass than I do with 20/20 vision. The glasses work the same for both of us, I just don't benefit from the effects. Also, stimulants do not work for about 10%-30% of people with ADHD, and if the reactions were truly that different, then there would be no controversy about testing for ADHD. It'd be as simple as just examining the effects of a pill.

In the beginning, I felt euphoric from stimulants and I am ADHD as they come. On the rare occasion, I still might get hit with a glimpse of it. Though that is typically after I take a break from medication for some time.

Back when I was in college, I cannot tell you how many people I knew with legitimate ADHD that used to rail Adderall and Adderall XR pills (yes, the XR are just as easy to abuse).

Check out this subreddit if you care. Search for the term "ADHD" and you will see how the medication affects a portion of the ADHD population:

https://www.reddit.com/r/StopSpeeding/

[adastra22]

There’s a lot of myth in this myth-correcting post. I’ve doubled dosed by accident and although I felt like my heart was going to explode (and was very anxious over that), I still felt absolutely nothing resembling a euphoric high.

If you have good vision you do not benefit from glasses. In fact it makes things worse, as those with good vision are able to use their eye muscles to adjust focus but the glasses make that harder.

[LoganDark]

> If one takes 120mg of Adderall in one go, then I can assure you they will not be calm nor relaxed.

If one takes 120mg of Adderall in one go, and they don't have a tolerance, I'd be surprised if their heart doesn't explode.

[idiotsecant]

Yes. Some brains react to some stimulants differently. That's the whole reason ADHD can be treated with Adderall.

[astrange]

This isn't true, it affects everyone the same way. But you could say the optimal dosage is different for different people.

I think people just like saying this because they're afraid stimulants will get banned otherwise.

[idiotsecant]

That's wildly inaccurate. A brain is a complex system with emergent properties that result in us. The basic effect is an increase in Norepinephrine interactions but the effect that has on people with ADHD is obviously very different.

It's like saying that engines with fuel and engines with no fuel respond the same way to adding fuel: it increases the length of time they will run.

Stop adding fuel and the resulting system behaviour will be quite different.

[hirvi74]

> The basic effect is an increase in Norepinephrine interactions but the effect that has on people with ADHD is obviously very different.

I've heard it described as a difference in magnitude. If a person with ADHD has an arbitrary "focus" score of 5/10, and a normal person has a focus score of 8/10. If a stimulant brings them both up to a score of 9/10, then the effects may appear more noticeable in the ADHD person because a 4 point jump is typically far more apparent than a 1 point jump.

[Arcanum-XIII]

I’ve seen friends with stimulant and can say with full confidence they are not reacting to them the way I am. They’re « high », ideas everywhere and nowhere, acting like their overstimulated, full of energy… when I’m quieter, energy level normal, can think at one thing at a time without switching… and sleeping under the effect is not an issue. I a have great nap.

So no. Maybe if I try a récréative drug will I have my adhd multiplied, but here it’s not. I think it should have been fun while younger discovering that amphetamine could quiet me when everyone was dancing under the influence.

It’s not perfect. No medication are. If you abuse it, take it without need… yeah it can be abused. Don’t try heart medication either. Or lithium for kicks. Or…

[hirvi74]

> I’ve seen friends with stimulant and can say with full confidence they are not reacting to them the way I am.

That means very little. Do you think all people react the same way to all medications? If someone takes an SSRI and it doesn't work, then does that mean they do not have depression, anxiety, or whatever the medication is indicated for? Do opioids only work for people with chronic pain?

As someone with ADHD, it's extremely common for people with ADHD to think they are some sort of rare subspecies of humans where everything different in their life is due to ADHD. In all aspects of life, people with ADHD are far closer to normal than they might want to believe. It's why people even doubt the existence of ADHD at times. I've yet to see anyone seriously doubt the existence of Schizophrenia, for example.

[wafflemaker]

All drugs affect everyone differently. Something that's ok with you can literally kill someone else - simple example - smoking weed with someone that has some lung disease.

That's why just having them illegal makes them 100x more dangerous. Through less knowledge among users, no guidance on packaging and difficult to identify the substance if someone had to be taken to the hospital.

[lazide]

Literally not true. There are clear, reproducible, and obvious differences in brain chemistry between people.

[LoganDark]

> This isn't true, it affects everyone the same way.

Adderall causes me to be essentially unable to move or function. When I tried it, I was very hungry but I couldn't get myself out of bed to get food so I had to sleep it off! Pure dextroamphetamine works a treat for me though.

[bratwurst3000]

this is true. Regular people get hyperfocus and adhd people get focus. real adhd is a neurologic disorder. its an instability in the flow of dopamin. so adderall puts dopamin flow on 200% and suddenly there is a steady flow for adhd people.

there are maybe 10% of people getting not focused and awake of adderal.

But "adhd brain reacts different then regular brain" is not true. For both its 20x dopamin release in 8 hours.

[hnthrowaway847]

I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.

I was on various forms of prescribed amphetimines for years and developed paranoia. It took me a few years to somewhat recover. My family has PTSD about that period of my life. I can’t think or communicate well anymore. Fuck that industry.

[neuronexmachina]

> I wouldn’t be surprised if this study were funded by some pharmaceutical lobbying shell organization.

Funding info is at the bottom of the article, the project was primarily funded by the Swedish government.

[vbril]

Also in that section:

> LZ is supported by ìShizu Matsumuraîs Donation (2024-02228) and KI Research Grants (024-02570). LL was supported by the Swedish Heart-Lung Foundation (20230452), the Söderström König Foundation, and Fredrik och Ingrid Thurings Stiftelse. BD was supported by a grant from the American Foundation for Suicide Prevention (AFSP). SC, National Institute for Health and Care Research (NIHR) research professor (NIHR303122), is funded by the NIHR for this research project.

It may be none of them. It may be all of them. There could be corruption. There could be subtle manipulation. You have no idea how much money there is in the industry. They make things happen.

Some in the medical profession believe that these abused drugs are safe for their patients. Others know better but they still prescribe them. Some pharmacists will tell you that they’re good for your brain because they increase blood flow, because that’s what they’ve been sold by the reps and the studies they’re fed.

[intended]

The fear over a paper, which can be studied and evaluated, is much higher than it need be. It would be something else if it were a media release, advertisement, or an actual compound being lauded.

[astrange]

It doesn't matter who funds a study if it's properly designed. You see this kind of dismissal on /r/science all the time and it's always just evidence that they're not qualified to actually read the study.

[shlant]

> You see this kind of dismissal on /r/science all the time and it's always just evidence that they're not qualified to actually read the study. reply

In my experience it's more because the conclusions butt up against the persons personal beliefs or experiences (like OP's)

[will_e]

Respectfully disagree.

I knew someone that worked for the tobacco industry where they had labs that constantly were looking for reasons that tobacco was good for you. It meets your qualifications for properly designed studies, but it was purely about trying to convince convinced others that a known addictive substance that caused emphysema and lung cancer was beneficial to your health.

Something similar happened in the weed industry, though it it’s proponents were initially just people that wanted pot to be free for anyone to grow, and then it got taken over by capitalists that didn’t mind using massive amounts of energy to fund vertical gardening, or genetically modify yeast to create THC, or to genetically modify the plant itself to produce an untested derivative of it that would meet the qualifications for hemp products, and then peddle it to teenagers at massive doses without control, pairing it with sugar-free sweeteners and causing serious health problems like uncontrollable vomit coughing, basically inventing a new disease from scratch.

[astrange]

> I knew someone that worked for the tobacco industry where they had labs that constantly were looking for reasons that tobacco was good for you.

If you're implying publication bias, that's addressed by preregistration, though you either have to be careful about looking it up or else rely on meta-analysis.

Otherwise if they're publishing true results then there you go. Nicotine does have some benefits; it's basically the only effective nootropic and it's pretty effective for schizophrenia which is why almost all schizophrenic people are smokers. Of course the problem is it's super addictive and all the ways of taking it give you cancer.

[nicholta]

> convince convinced

You probably didn’t mean to add “convinced”.

https://truthinitiative.org/research-resources/tobacco-indus...

https://pmc.ncbi.nlm.nih.gov/articles/PMC2564674/#:~:text=In...

> massive amounts of energy to fund vertical gardening

You probably instead meant “massive amounts of energy in vertical gardening”.

https://www.nature.com/articles/s41893-021-00691-w

https://pmc.ncbi.nlm.nih.gov/articles/PMC8349047/#:~:text=Ho...

[nickff]

The only thing more popular (on those/these forums) than shallow dismissal is piling on (i.e. the recent Coldplay episode).

[bawolff]

Afaict the study was not looking at the risk of that type of side effects.

In any case, paranoia is a known potential (but rare) side effect, its not like pharma companies were keeping this a secret.

[shlant]

"I experienced negative side effects so the science must be bought and paid for"

[ljf]

I found this article about the steps the DEA are taking, really interesting https://www.catherinemccarthymd.com/med-shortage-news-1/the-...

[unethical_ban]

You're right, and the situation is a harm to those who need adderall. Besides, adderall is not nearly as dangerous as Opiods. Whoopty-doo if it's diet Coke. This is why, even though I don't like Adderall's side effects for my ADHD and don't use it often, I keep the prescription, because fuck the government trying to squeeze pharmacists and doctors.

[chipsrafferty]

So even though there's a shortage, you're keeping your prescription to "fuck the government" but actually only fucking someone who needs it and cannot get it?

[LoganDark]

Yep. No matter how long I've been taking my ADHD meds, I can just stop them at any time. I'll sleep for a while (I think my record is 25 hours of sleep), but that's it. No life-threatening withdrawals. No panic. No pain. Safer than any opioid (except perhaps naloxone?).

[mithametacs]

The withdrawals are fucking garbage from even mild abuse (3x prescribed). I passed out and cut my head. And was anhedonic. And lethargic.

And I started taking it as an adult. So I had 4 or 5 ADHD diagnoses under my belt.

[phendrenad2]

The DEA is a runaway paperclip maximizer[1]. Their directive is "prevent drug abuse", and they will continue to pursue that goal to the detriment of everything else. There is ZERO feedback loop here. You need to build that feedback loop of you want one. It's your government, shape it how you want it.

[1] - https://hackernoon.com/the-parable-of-the-paperclip-maximize...

[99_00]

All abuse is bad. Some abuses are worse than others.

What abuse are they seeing with adderall? What I hear in casual conversations is that people are abusing it to learn things. Is that what the DEA was seeing too?

[hirvi74]

> What abuse are they seeing with adderall?

Probably accounts that were similar to these:

https://www.reddit.com/r/StopSpeeding/

[graemep]

Yes, it is most commonly used a study drug.

It is a strong stimulant (more like cocaine than like coffee) and potentially addictive so potentially dangerous and requires medical supervision.

it is a formulation of amphetamine.

[notfromhere]

You aren’t really going to get addicted to therapeutic doses. Recreational doses are like 5-10x what a doctor would prescribe, with restrictive laws in the U.S. you can only get a months supply at a time.

Would be pretty dumb to use your months dosage for 3 days of partying

[graemep]

The question was "what abuse are they seeing with Adderral?". Abuse is mostly going to involve illegal supplies and illegal use.

> Would be pretty dumb to use your months dosage for 3 days of partying

It would be, but people can be pretty stupid. I know personally of a case where kids were sharing their doses.

[chipsrafferty]

Very few people are taking 350-700mg of Adderall... Recreational doses can be lower than the highest prescription dose.

[99_00]

It can't be as appealing and addictive as cocaine but most commonly be abused as a study drug and have recreational use be much less common.

It would never happen. So it must be much less appealing than cocaine.

[adastra22]

I didn't realize studying was a crime.

[graemep]

Using controlled substances to study is a crime. Working is not a crime either, but using cocaine to be able to work harder is a crime.

[lazide]

wall street looking around nervously. Oh who am I kidding, no one cares about that one.

[elcritch]

I think of this stuff when folks say “trust the science!”. It’s all trust the science until that science conflicts with some broader agenda of a federal agency or a doctor’s whims about risks to their license.

Medicine really has a bad problem with groupthink. To get the best healthcare you have to both trust physicians and be critical of them.

Then the DEA seems to consider stimulants as a moral failing.

I’ve been off Concerta for 3-4 years now because it was so difficult to keep my productivity up when the pharmacies near me ran out due to the unpublished extra-legal DEA caps on stimulants.

Luckily even have been on Concerta has helped me learn how to manage my ADHD a bit better. It also gave me the chance to heal some of the worst traumas due to undiagnosed ADHD.

[graemep]

I think "trust the science" is a stupid slogan anyway. Not all science is equally well proven. Who represents the "science" when scientific opinion i divided? Even when there is a consensus there are plenty of examples when a strong consensus has been wrong.

The end result is that i tends to make the public regard science as something that they are told by experts, so then it becomes a matter of which experts they trust. This ultimately undermines trust in science because some expert opinions turn out to be wrong.

We really need better science communication, which will not happen when the media want sensation, politicians want spin, and the public believe either the media or ChatGPT or some random nutcase on Tiktok.

[adastra22]

"Trust the science" is anti-science. The whole point of science is that you don't have to "trust" it.

[graemep]

You need to trust the data, of course, and the process is carried out honestly.

Non-specialists in any field cannot understand everything, but I think good communication could still do a lot of effective explaining of evidence.

[abtinf]

> she’s actually really reasonable and I like her

From what you’ve written, she didn’t treat your actual condition and thus put you through needless suffering and placed your health at risk.

[llbbdd]

Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.

[baby_souffle]

> Which online doctor? I've had the same frustrating experience with "real" psychiatrists but didn't know you could arbitrage the prescription like that.

There are a few providers out there. The DEA is cracking down on them (they call them "pill mills") and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years. The /r/ADHD sub has some good discussion(s) from time to time on the latest action(s) taken by the DEA.

---

When I was seeing medical help to confirm or refine my suspected/self-diagnosed ADHD, it was a _pain_ to jump through all the hoops. I was nervous getting my first Rx filled but oh my god was it a night and day difference. Within 45 min, it was _clear_ that the medication was working ... exactly how it's supposed to for people with ADHD. That "validation" was my prize for attempting to navigate the american health care system.

If I could have replaced dozens of hours / 6+ months of phone-tag/paperwork/assessments for a monthly subscription and a 30 min video call, I'd have jumped at the chance.

[skissane]

> and that crackdown is - depending on who you ask - partially/fully responsible for the stimulant shortages the past few years.

Australia has been experiencing psychostimulant shortages in recent years, but they haven’t been due to the DEA (or Australian equivalent thereof-most of the DEA’s functions are state government responsibilities in Australia), they’ve been explained as due to manufacturing issues and growing demand - https://www1.racgp.org.au/newsgp/clinical/further-adhd-medic... - while I totally believe the US is facing additional issues due to its own regulatory regime, if Australia is having supply issues independent of that factor, why wouldn’t the US too?

Since controlled substances prescribing is a state issue in Australia, each state has its own policies - but I know my state (NSW) has been loosening regulation not tightening it - https://www1.racgp.org.au/newsgp/clinical/first-phase-of-gp-...

[Maxious]

The shortages are due to the DEA, you can read the documents on the TGA FOI website what "manufacturing issues" really means https://www.reddit.com/r/ausadhd/comments/1mhdmgs/foi_250162...

[skissane]

Since last year, lisdexamfetamine sold in Australia has been manufactured in Germany (API) and Ireland (packaging). The DEA has zero jurisdiction over a drug manufactured in Germany/Ireland and then exported from there to Australia–US quotas do not apply, the relevant quotas are the German/Irish/Australian quotas set by their respective governments (which governments appear to take a much more flexible and responsive approach to doing so than the DEA does). Takeda said that GMP issues in the Irish plant were causing supply problems – and I don't see any reason to disbelieve them; GMP is a TGA/FDA/EMA issue not something the DEA has any authority over.

The biggest cause of Australia's lisdexamfetamine supply issues isn't the DEA, it is patent law – the US patent expired in 2023, the Australian patent doesn't expire until 2028, which gives Takeda a continuing near-monopoly on lisdexamfetamine in the Australian market – so if Takeda is having problems meeting the growing demand, it is legally very difficult for other firms to step in. The TGA did for a period allow emergency parallel import – but I don't know if that included generics, and my own experience was it wasn't clear how to even access it – my impression is that for most patients it was more of a theoretical allowance than something practically helpful to them.

I think the biggest thing the DEA is doing here is damaging the US' own pharmaceutical manufacturing industry by pushing controlled substances production out of the US and into friendlier countries in Europe and Asia. The DEA can't cause any lasting issues with controlled substances availability in Australia because their jurisdiction is legally limited to the United States. Even if we suppose the DEA may have temporarily contributed to supply issues in Australia – surely equal blame lies at Takeda for being too slow at moving manufacturing out of the US.

[wahern]

That document is quite confusing, at least when skimming it. There's actually a bullet point on one page that says, "The current interruption to supply is NOT related to any DEA production quotas or restrictions on API."

That may be technically true, or perhaps it's just a false assertion included in the document dump. But AFAIU the issue is that the DEA tightly controls production and distribution of bulk amphetamines. There's just not a global quota, but per manufacturer quotas as well as requirements for allocation for each product. For example, the DEA sets a supply quota for 40mg pill production separate from a 50mg prescription. So if a particular manufacturers supply for 40mg pills is exhausted but they have tons for 50mg pills, too bad unless and until you go through an onerous process with the DEA to reallocate. It gets even worse across manufacturers. If manufacturer A has to shut down their production facility for some reason, manufacturers B and C can't easily pick up the slack. That's because reallocation of amphetamine supply to another manufacturer not only requires navigating a bureaucracy (that the DEA may very well slow walk given their present attitude), but it requires manufacturer A to voluntarily relinquish their quota, which they never do as there's zero benefit to them.

TL;DR: Technically global supply is more than adequate, but DEA rules, which effectively operate extraterritorially, create huge distribution problems. So the DEA can technically claim quotas aren't the problem, but that's at best highly misleading. If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.

[skissane]

> There's just not a global quota,

There is no global quota. There are national quotas set by every country's government. US law nominates the DEA as the agency which does that for the US. Each country's government reports their national quotas to a UN agency (the INCB), but the UN agency has no power over them – at the very worst, they might criticise your quotas, but probably not even that; and more powerful countries (not just the US, even middle powers like Australia) can ignore what UN bureaucrats think with impunity – some poor developing country it may be a different story, especially if aid decisions are tied to getting a "good report card" from those bureaucracies.

And while for the DEA, setting these quotas is part of some grand moral/ideological crusade, for EU governments and Australia it is just technocratic paperwork – so of course those governments approach the issue much more reasonably than the DEA does.

> but DEA rules, which effectively operate extraterritorially, create huge distribution problems.

I don't see how they do. Lisdexamfetamine sold in Australia is manufactured by Takeda in Germany and Ireland. The DEA lacks jurisdiction over what a Japanese company does in EU and Australia. Although the drug was originally developed in the US, the Australian patent is currently owned by the Japanese parent company, not its American subsidiary, while the American subsidiary owns the "Vyvanse" trademark in Australia; anyway, DEA jurisdiction is based on manufacture in the US or US import/export, not country of development or IP ownership.

> If manufacturer A has to shutdown production (which, from the document, seems to have been one of the issues with Takeda), the end result is less production even though other manufacturers could theoretically pick up the slack.

In Australia's case they can't because lisdexamfetamine is still under patent, so other manufacturers are illegal – not because of the DEA, because Takeda will sue them. Takeda could license other manufacturers voluntarily, but why would they do that? That might be great for patients, but probably not so great for their shareholders.

I'm no fan of the DEA, but blaming the DEA for something that happens in Australia appeals to people emotionally even if it isn't true, whereas blaming patent law and the business decisions of a Japanese corporation is more truthful but less emotionally satisfying.

[adastra22]

Circle is pretty easy to work with.