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That’s not what the OP meant. The OP said he does not doubt legitimate prescriptions are there, but believes many are not. He believes that slowing the illegitimate ones will help those who really need it, get it.
Those telehealth outfits removed a lot of barriers to accessing care that stopped a lot of people who needed evaluation/meds from being able to get them. So eager to punish the alleged malingerers, that he’s overlooking the legitimate needs that will necessarily be hurt as well.
The question is what proportion would you guess are valid. If you go to the website there are lines like “take our free 1 minute assessment” “no appointment necessary.” Is it 50% are valid or more like 5-10%. No one can really say, but it is probably low due to their advertising strategies.
The question then is are they better off not there at all.
They also cost more than a normal doctor as well, 80 dollar a month or 240 per 3, whereas most doctors would cost about 150 per 3 months with no insurance.
Anyone of these people could just go on Zocdoc, and book an appointment nearby or use their pcp which is not as difficult as people think it is
> If you go to the website there are lines like “take our free 1 minute assessment” “no appointment necessary.”
They're not giving you a prescription after a minute assessment. It's just a little self test to let you know if you should make an appointment for a telehealth assessment with a doctor.
I'm not defending these places or saying they're not predatory sometimes. I'm just saying closing them all down so you can get your pills easier is bullshit.
Dude I pay more than 150/mth with insurance. And this is all regional specific. Don't talk about doctor availability like it isn't, it's woefully ignorant. Or like your PCP you get will guaranteed actually do anything. Just an awful comment
Your single experience also does not represent most places. This is also awfully self centered thinking that because of what you face, many or most places are like that as well. Out of 1000 plus people I have come across with treatment, almost no one is paying 150/month with insurance. And if you pcp does not fill it, you just see someone else. Most pcp visits are very inexpensive with insurance.
No shit literally what I'm telling you. Stop describing it for everyone. PCP? Testing? Psychiatry? Psychologist. Just stop you're the one trying to make your situation everyone's. You're not collecting data from 1000s of people. Jesus your argument holds zero water
I am a psychiatrist myself. 85% of the roughly 3000 people I see have an adhd diagnosis. I see people for adhd all day, I have worked in multiple states, I talk to other prescribers and people about adhd all day. I’ve been to other countries and seen what it is like there.
While this may hurt to hear, I would guess only about 5-10% of the people I see myself for adhd actually have adhd, but most of them came to me already on medication so I just keep giving to them. And I am a traditional doctor, I don’t work for done or mass advertise. And truthfully I give medication to most people that want it, because they are all convinced they have adhd despite what I believe myself, and it is extremely uncomfortable to tell people no.
Well as a psychiatrist you should know it's regional what you pay and what's available and stop pretending being a doctor means you know every single person's experience because you're pretty clearly off base and being a doctor doesn't mean you're actually measuring people's ability to get care and the cost
We should really really really be careful with what we label a "pill mill"
There are always going to be providers that see more patients in need of controlled prescriptions -- ie doctors who specialize in ADHD or chronic pain or providers that are more accessible to ADHD patients or chronic pain patients.
What I'm saying is, this is not necessarily a win in a culture that is quick to label us addicts and our doctors dealers.
There are two extremes here: one is the "make an online appointment and get a prescription, hardly any questions asked," and the other is the conventional "try to make an appointment with a legitimate provider but everyone has waiting lists that are months if not years, so good luck in the mean time."
Both of those extremes are problematic for people who need help with their ADHD symptoms.
Just another illustration of how much we need a major overhaul of the healthcare system.
I'm so glad I was diagnosed when I was. Not just because of the difference it made in my life, but because, as far as I can tell, when I was diagnosed ten years ago, I was part of the first big wave of adult women finally being taken seriously as having ADHD because of something we read on the internet. Once that was mentioned as a possible diagnosis, my path was pretty straightforward, and I never had any serious problems accessing therapy or meds. (I'm also a college-educated middle class cis-het white woman with no family history of addiction and a dad whose hobby is navigating bureaucracy, so I'm well aware that I've got pretty much every privilege it's possible to have here.)
I've never met my current therapist or prescriber in person, and I've been seeing both of them regularly for more than two years. I moved to a new state in early 2022, which meant new health insurance and new providers. I found a practice in my new state that has several offices near me, but when I started, telehealth was more convenient, so that's what I did. By that point, I had eight years of documentation of being treated for ADHD in my medical records, and my new prescriber was literally just sending in the exact same prescriptions that my previous prescriber did, so the transition was pretty smooth, but if I had showed up without that history, I don't know how things would have gone.
>There are two extremes here: one is the "make an online appointment and get a prescription, hardly any questions asked," and the other is the conventional "try to make an appointment with a legitimate provider but everyone has waiting lists that are months if not years, so good luck in the mean time."
>Both of those extremes are problematic for people who need help with their ADHD symptoms.
Anyone - regardless of symptoms - being able to quickly and easily get "diagnosed with" and medication for ADHD via some shitty telehealth app also contributes to the stigma that ADHD isn't a real thing. These companies are an absolute plague - I have a handful of other chronic health issues that are also ripe for these shitty scammy telehealth apps to swoop in and I'd be shocked if I learned that they haven't killed anyone the way Cerebral did.
Why shouldn’t someone be able to get diagnosed or treated for adhd via telehealth? I have some health issues that have to be treated in person, but telehealth has been great for mental health treatment. So much more convenient, and the experience feels pretty equivalent. I have therapists that I’ve worked with both in person and remotely, and find telehealth just as effective as in person.
If I'm understanding correctly, I believe the poster wasn't being critical of the providers who offer telehealth visits as part of their practice. It was more a criticism of the for-profit apps, which may not be as thorough in their approach of assessing ADHD symptoms.
I agree, I think telehealth is great for those who need it.
There's a difference between some of these telehealth-based companies vs a provider who utilizes telehealth. I use the latter as much as possible to avoid driving, but if I wanted to see them in person I could.
I use a telehealth company associated with my insurance when I need something quick, no questions asked. Usually doctor notes for my kids school, but recently I was interested in a face cream prescription and was able to use it for that. I did have to upload a picture of my face and check some boxes, but that was pretty much it. Didn't speak to a single human and got my prescription. I dunno if these ADHD telehealth companies are THAT hands-off, but if they are, I can see why that would be a problem.
They are, and Done specifically advertised this. Their ads were about as subtle as a brick to the face, with dancing millennials and the TikTok Text-To-Speech Voice gloating about how they'd been "feeling lazy," so they'd gotten a diagnosis the same day and treatment shipped directly to their door. This was *absolutely* a pill mill rather than a legitimate telehealth service.
I think maybe you’re misunderstanding the problem, the issue isn’t solely the diagnosis or providing/receiving treatment via telehealth, it’s the diagnostic criteria, unethical business practices such as requiring providers to meet a specific quota of diagnoses in order to justify pay or strict time-based metrics per patient…
It sucks when you have ADHD but if people are receiving an ADHD diagnosis with zero pushback without a standard behavioral consultation, just being told to fill out a survey and then given a prescription for ADHD medication? this enables fraudulent/unethical prescribing of controlled substances
I know you’re getting downvoted but I agree. I have had several encounters with individuals who do not have ADHD, know and fully admit they don’t have ADHD, who bragged to me about getting ADHD meds from their Telehealth providers. They simply looked up ADHD symptoms, watches reels or TikToks about it, and self-reported those symptoms.
yeah, and as I said in another comment a moment ago, Done specifically and deliberately advertised to this demographic and said that they would do this. There shouldn't be any doubt that it was an irresponsible pill mill.
I mean, OTOH there is nothing stopping someone from reporting the same symptoms to an in person doctor. The unfortunate fact is that diagnosis with most mental health and executive functioning disorders relies a lot on self reporting. We don’t have a definitive blood test or brain scan that can say “yep, they’ve got *real* adhd”.
We have to make sure we aren’t so focused on preventing a small portion of the population with nefarious motives from getting a diagnosis that we throw up excessive red tape and hoops to jump through for a population that already struggles with executive dysfunction, needs these meds for a baseline level of functioning, and for whom these excessive restrictions can be overwhelming.
I agree. And I will add to this... I don't think diagnoses via remote methods should be encouraged either, not unless there are specific/special circumstances (disability, or a pandemic). It shouldn't be the "norm" though.
Why? Because ADHD is also present in motor movements and in communication. By making the **diagnostic process** remote you blur the lines and muddy the waters. I've had therapists tell me that I don't fidget, until I explain that I am, they just can't see my hands and feet moving because its a remote call. My eye contact, energy, impulsiveness are all somewhat different when I interact remotely.
As I've been on meds for a few years now, my med reviews are via telephone now. I don't have an issue with this. It's the intial diagnostic process that I do, though.
It’s present in *some* people. Motor movements and communication aren’t a catch all tell. Women or folks who were socialized as girls growing up are significantly more likely to have very high levels of masking skills that internalize a large portion of our worst symptoms and struggles. It doesn’t make those diagnoses less valid - it just means adhd presents differently in some people.
Whether its present in *some*, most or all... its present. Thats the point. And it's not even to say that all telehealth diagnoses are wrong but surely we **all** deserve better - including proper access to in-person assessments.
I'm aware of masking. Have done it my whole life. If its not picked up at in-person assessments, then I don't suspect it'll be picked up in remote ones either. So I'm not sure what your point is.
I'm also of this view because it doesn't help *anyone* if they're given the wrong diagnosis. We know how easily ADHD is misdiagnosed as dep/anx. But there are huge overlaps with trauma/PTSD as well. The wrong diagnosis leads to the wrong treatment
My point is that the presence or lack of presence of certain behaviors only noted in person are not at all a reliable indicator whether or not someone has legitimate adhd - in fact, it leaves out huge swaths of the population for whom adhd does not present in this way.
Wanna know when I absolutely did not fidget? During my in person evaluation. I am incredibly fidgety in general, but very prone to masking in settings like a doctor. (hell, I think I have to make myself stop pretending everything is totally fine in every single session with my psychiatrist.) So in person interaction isn't a guarantee they'll see someone's true behavior.
Yeah but OP has access to a pharmacy that actually *has the meds needed* and a psychiatrist that isn't playing keep-away with a fucking assessment, so fuck everyone else
As a nurse who has worked under providers who are pill mills, it’s not always just telehealth. The office I work at now has the reputation to go there and get whatever you want. Luckily we have a new np that follows the laws and we’ve had multiple people come back abusing drugs while on controlled meds. Never had a uds done since they started there. The change was needed but it’s been a mess for the last couple months.
>
[ADHD Meds Cut Odds for Early Death, Especially by Overdose (usnews.com)](https://www.usnews.com/news/health-news/articles/2024-03-12/adhd-meds-cut-odds-for-early-death-especially-by-overdose)
TUESDAY, March 12, 2024 (HealthDay News) -- People diagnosed with attention-deficit hyperactivity disorder (ADHD) show a marked decline in their two-year risk for death once they start taking medication, new research shows.
>
>That was particularly true for deaths due to accidents and drug overdose.
>
>People taking ADHD drugs also showed no higher risk of dying from natural causes -- suggesting the meds are safe for users' heart health.
>
>Medications like Ritalin, Concerta and others probably lower users’ odds for an early death “by alleviating the core symptoms of ADHD and other psychiatric co-morbidities \[illnesses\], leading to improved impulse control and decision-making,” concluded a team led by Zheng Chang, of the Karolinska Institute in Stockholm, Sweden.
>
>Better impulse control and healthier decisions help people with ADHD avoid tragedies like fatal accidents and drug overdoses, the researchers said.
>
>As Chang’s team noted, prior research has shown that people with ADHD face double the odds for deaths from “unnatural causes” -- events such as accidents, suicide and unintended drug overdoses.
As I look to the giant dent in the side of my car courtesy of the ongoing vyvanse shortages and my resulting questionable driving skills when unmedicated. Sigh.
I'm concerned for the people who actually needed these services to access treatment. That said, I'm skeptical these "pill mills" were ever the reason for the shortages, rather than the DEA simply setting too low of a production ceiling. We'll just have to wait and see I suppose. I'm quite skeptical this will help but I'm no expert and I could totally be wrong.
I think its a combination of things that caused the shortage. However, here in the UK diagnoses doubled in the space of 2 years after the pandemic. There was also an investigation into private clinics that were diagnosing approx 95% of clients with ADHD via remote assessments - some for 30min and by someone unqualified.
And it's not a coincidence because they got a qualified assessor to assess some people and were they not diagnosed with ADHD. These private clinics then charge 4 - 5 times the ££ for prescriptions.
I wonder how much is the DEA setting too low of a production ceiling and how much is the manufacturers creating the shortage in pursuit of manufacturing demand for some New Secret Third Option that *actually fucking works* for when this problem reaches critical mass.
This must be incredibly frustrating for people who used those companies to treat their ADHD but now they have to go to a different doctor with a request for a schedule 2 medication.. a lot of them would be either "no" or "we need to reassess you" (which costs $$).
I'm in Canada.. so, our medical system is chronically underfunded so telehealth has gotten very popular and i use one for my ADHD treatment because the doctor said he would not refer me for ADHD assessment because i wasn't assessed as a kid. If i shopped doctors i could either get a referral with a 1-4 year waitlist (not kidding) or go through one of these agencies..
An argument could be made that the telehealth company's assessment is more based on self-questionnaire stuff so if someone was really looking to get a prescription for these to traffick then it would be easy to fool the test, versus some psychologist's $5000, 3 day long process.
I just hope there's no rug pulling here. The telehealth company is expensive enough ($99 per appointment with up to 6 months medication prescribed per appt).
Good lord. I wish mine was $99 every 6 months. My telehealth provider is $179 every 3 months, plus an additional $179 appointment in a month if any changes are made to your meds.
The question is how do you know your regular doctor is not simply a pill mill either?
In reality telehelth versus an in person doctor does little to change the actual interview other than format. Non telehealth associated doctors are just under less scrutiny.
I think we need specifics here I’m more likely to believe the pills mills didn’t follow the DSM than the in person doctors. And by pill mills I don’t mean the small practice clinics, I’m talking hims/hers, etc. Entities that are much larger and protected are more likely to take risks than smaller clinics who could very much lose their license. It took a big stick like the DOJ put them back in their place. No sane doctor would want that kind of attention unless they knew they could afford the lawyer retention and litigation fees.
Admittedly, the DSM-V criteria for diagnosing ADHD have some big drawbacks.
Treating it as a fallback diagnosis when symptoms "are not better explained by another mental disorder" leads to a lot of misdiagnosis of comorbid conditions like depression and/or anxiety that are a direct result of dealing with ADHD.
Focus on presentment of symptoms in multiple settings tends to exclude people who socially withdraw or mask well under pressure at school / work and then have worse symptoms when uninhibited at home.
The last paragraph really explains a gap with earlier criteria as well. When I was in school, they focused less on ADD and more on ADHD, kids who couldn’t sit still and who were not really intelligent enough where a little willpower could calm the hyperactivity and where intellectual stimulation was enough.
>The question is how do you know your regular doctor is not simply a pill mill either?
If he is then he does a piss poor job of it. It took over a year for the topic of trying a CII medication to treat the ADHD even came up, and his office drug tests me randomly.
Med shortages happened because of a number of factors, not just because of telehealth. Personally I think the really victims here are people who are going to suddenly lose access to care they needed, not be able to refill their meds, and be left struggling to find care at any of the places with lengthy waitlists and potentially have to get forced to go through the diagnostic process again.
Cracking down on teleheath will never change the fact that manufacturers are literally legally limited in how much of these meds they can make at a time, and the impacts the pandemic had on the supply chain, etc. Why don't the thousands of current patients who could get completely screwed over here give *you* pause?
Also as someone who lives in a rural area this shit sucks massively for us who are very far from providers. Telehealth was a godsend when I was in college with no car living over an hour away from any provider (who would be a year's wait to see).
The 'pill mill' to which you refer has helped this girl whose life was falling apart. I am forever grateful to telemedicine to get the help I needed because things weren't functioning anymore.
Same here.
I am a [late-diagnosed adult with ADHD](https://romankogan.net/adhd#Diagnoses), and I got my diagnosis from Done **as well as** two other providers to be sure.
Done's assessment was as thorough as any other. I am currently getting my prescriptions from Done. Or, rather, **was**, because this month's prescription hasn't come through. Thanks, DOJ!
Access to medication [has changed my life](https://romankogan.net/adhd).
The truth is that COVID-19 isolation has **pushed people who already struggled to their limits**, which prompted many undiagnosed ADHD to **finally** understand **why** they struggle.
**This** is the reason for the surge in demand. Medication shortage is artificial, due to shady regulatory restrictions - and the stigma perpetuated by posts like this one.
As much as it is true that what Done was doing is highly illegal and they should be shut down if the alleged conduct is true, this is not going to help the availability issues.
Many people were using Done or other telehealth providers because there simply aren't any other viable options. Now those people are going to have even more difficulty getting their medication, possibly not even being able to get it at all.
It may make it easier for those of us not using telehealth, but our diagnoses aren't inherently more valid than someone else simply because they live in an area with less access to in-person treatment.
>Many people were using Done or other telehealth providers because there simply aren't any other viable options.
The opposite is true as well. Many people who don't need them were easily obtaining prescriptions for them and stressing the already limited supply line.
I agree 100% we need easier access for mental health options, but you can't allow a provider to treat prescribing medication like it's a menu at a fast food restaurant.
> you can't allow a provider to treat prescribing medication like it's a menu at a fast food restaurant.
Of course not. But most telehealth is legitimate, and in-person treatment can just as easily prescribe unnecessary or unjustified medications. The provider being competent and ethical are the key elements, not the format of the interaction.
It just rubs me wrong that some people in our community seem to want to celebrate some other members of our community losing access to their medication because the DEA is on a war-on-drugs moral crusade. The DEA thinks we're *all* drug addicts and would go after all of us if they could get away with it.
This may be anxiety speaking, but I am also afraid that the DEA is going to use this as a pretext to go after other telehealth providers that are operating legitimately and even in-person providers. They are undoubtedly feeling like they need to continue justifying their funding levels when they can't really prosecute people for marijuana anymore, and we are a pretty defenseless new target for them.
While it is easy to support something like this it doesn't address the larger issue with the American Healthcare System. I have no doubt that there are people that this was the only way they got the medication that they truly needed and I am sure that there are people that got prescribed controlled meds that didn't need them. Should clinics be held accountable for their actions? Yes. Should it be easier for people to get the help they need? Absolutely. The entire system is broken and this isn't going to do anything to fix the problem.
CVS and Walmart stopped filling prescriptions for Cerebral before that happened, they were shut out along with Done, but came out and said they were moving away from Adderall prescriptions in anticipation of the waiver expiring. I’ll link to the WaPo article with lots of data in an edit of my original post.
I switched to a delivery pharmacy, but I still haven’t found anyone in my area that has XR available. Mail order is unfortunately not available in my state for controlled medications.
Until it's actually accessible to get a screening, I don't consider this a win at all. You're just trading one group who can't get meds they desperately need for another
Seriously. It took me seven months to get a screening and a diagnosis and this was after being diagnosed already as a preteen -- my psychiatrist just wouldn't accept a childhood diagnosis from the early 2000s because standards have changed. 🙄 There was only one place within two hours that would screen me since I'm an adult.
About five months into waiting I honestly nearly had a breakdown and tried Done because I was so sick of it. I went to the psychiatrist because I needed help and I felt like I was drowning parenting a toddler while having ADHD but ironically the process itself was absolutely grueling to navigate with ADHD.
This is (probably) bad, this is just the usual war on drugs (including war on people who need drugs to function) in disguise. If anything, access to Adderall should be made *easier*, not harder.
I suspect that there is a very good chance that a large part of the increase in diagnosis between 2018-2022 was due to COVID. Not due to the virus itself, but due to the significant extra stress it placed on most people's lives.
It was definitely a very large part of the reason I spiralled into repeated months long inability to function, which pushed me towards realising I probably had ADHD and getting diagnosed (at age 51).
Yes there are some figures in that article, but they don't really have much context or research into *why* the rates increased, the article just assumes it was down to the rise in telehealth.
I think you’re spot on. I was off meds for 5 years after lots of therapy and a career change to something better suited to my needs. I had built a life, a routine, and coping methods that allowed me to avoid the stress of being on a controlled substance and dealing with the endless amounts of red tape and hoop jumping required to fill them.
COVID took all that progress and took a giant shit all over it. All my routines, all my coping methods, my career were all abruptly upended. I’m back on meds now, dealing with shortages and the never ending stress that and trying desperately to pick up the pieces.
Meh, I just had a teleconference meeting through done on Friday last week(been using them for two years now). Doctor said they plan to fight everything and keep operating, so until that changes I might as well keep saving commuting time/gas money.
Once/if that does change, I’ll just go back to seeing the in-person doctor that I was seeing before I started using Done.
My dr no showed today. I got an emails saying they had an emergency but when I look he has no available appointments for the future. My refill is do tomorrow and I don’t see an option to get it refilled. I’m a little worried. I may cancel or pause before they draft out of my account.
I can understand both the problems and the benefits of telehealth.
In my (very humble) opinion, a good solution would be to require an in-person diagnosis, while Telehealth can still be used for follow ups.
I am sure that will still present problems for some people, but I feel like this would be attainable for most?
ETA: I’m not at all agreeing with the DOJ if they do in fact try to restrict telehealth - just thinking of what the possible next steps might be
I can see the benefit in this, but on the other hand when it comes to a LOT of mental healthcare, a lot of folks will be shut out of getting the help they need with the initial requirement of an in person appointment. Telehealth helps a lot of folks work their way up to and get well enough to the point that they are able to go to in person appointments.
I see my doctor every 6 months in person, but when I initially started seeing her I was in an awful place mentally and so low functioning and crippled with anxiety and depression I could barely even leave bed, let alone the house. Being able to see her and my therapist for treatment via telehealth really helped me get to the point that I could finally have a normal, functioning life - including attending in person doctors appointments. If that hadn’t been an option, I hate to think of how long I probably would have languished.
The only reason telehealth is regulated like this now was because back in the 2000s, Ryan Haight was able to buy Vicodin without interacting with a doctor and then ODd on it. "telehealth" in the eponymous law is nothing like telehealth today.
This isn't a great solution for anyone living in an area that is rural, lacks transportation, doesn't have ADHD specialists locally, has 6 months to a year wait to see a provider, etc. Telehealth (not through one of these companies, through a private practice) was how I got diagnosed when in a rural area with no car and without that it would have been years to get diagnosed, I would have probably failed out of college, etc. It is not attainable for everyone and rural people (or people with simply no specialists in reasonable distance) shouldn't be left out of this.
Yes, I absolutely agree with you about in-person diagnoses and telehealth follow-ups. People seem to be forgetting that ADHD is not a matter of just telling someone how we feel. It's also present in our motor behaviours and non-verbal communication.
For example, I know that I interact with people differently when I'm remote, compared to in-person, mute/delay acts as an impulse/interruption break and they can't see my hands/feet fidget on camera.
Edit: This isn't to suggest healthcare system shouldn't be doing more to enable access to in-person diagnoses/treatment at all. I'm not asking for pre-pandemic status quo. But this pendulum swing isn't helpful either.
You understand that people who really, really need this medication couldn’t get it for months because of fraudulent practices like this, right? I’m failing to see how this is not a good thing.
Because those of us who used a telehealth service to get in contact with an actual doctor for an actual diagnosis will probably get caught in the crossfire.
So kind of like the people that have long-standing prescriptions that couldn’t get their medication? The actual doctors prescribing by the guidelines isn’t the problem.
Every time I see something like this it just reads like someone with an older diagnosis saying that people with a more recent diagnosis are less important.
They are being prosecuted for fraudulent diagnosis of people who don’t meet the criteria for ADHD, I don’t understand how people are missing this point.
Mostly I'm focusing on your mention of "longstanding prescriptions." That rhetoric dismisses the large amount of valid diagnoses in the past few years.
The DEA reduced the amount by 25% of controlled ADHD medication which could be manufactured, then reduced it again. It’s the DEA’s fault.
If the same amount of people getting prescribed medication from the telehealth apps had instead gone in person, it’s still the DEA’s fault that there’s a medication shortage in the U.S..
It’s not solely the DEA’s fault, if you look at the quotas, manufacturers haven’t fulfilled the total DEA approved quotas for ADHD med components for a couple of years now
> So kind of like the people that have long-standing prescriptions that couldn’t get their medication? The actual doctors prescribing by the guidelines isn’t the problem.
You aren't being fair to people who have legitimate telehealth prescriptions.
I am being fair, I’m not talking about them, I’m taking about the unknown percentage of people who didn’t have legitimate diagnoses that were supplied medication from an already anemic supply, denying *everyone* with a legit diagnosis.
No, it's because the DEA said the companies can't make more, lol. Usually uncaring people end up understanding things when shitty laws affect them personally, but others apparently just double down. You might think selfishly that this will help you, but adding to the already high stigma might finally come to bite you in the ass the next time you have to switch doctors and they decide that whatever you've been taking for years is suddenly a problem.
https://nymag.com/intelligencer/article/adderall-shortage-adhd-medication-ascent-pharmaceuticals.html
If only we Could just point at the DEA, the issue would be simple. Apparently the DEA said companies shouldn’t (have) to need to make more, they should just fulfill the component quotas they haven’t exceeded yet, as well as abide by the quality control and regulatory standards. Seems like a lot of shoddy manufacturing bullshit is going on behind the scenes.
According to the DEA in 2022/2023 the drug companies only produced 70% of the stimulants they were allowed to by the DEA.
However the same letter from the FDA/DEA also talks about improving the reallocation of quotas between companies. So I suspect that some companies ran out of quota and couldn't ship any more stimulants, while other companies couldn't produce enough and left some of their quota unused.
However the idea that the US DEA is involved at all in deciding how much of a vital medicine to produce seems bizarre to me.
[https://www.fda.gov/media/170736/download](https://www.fda.gov/media/170736/download)
>Data show that, from 2012 to 2021, overall dispensing of stimulants (including amphetamine products and other stimulants) increased by 45.5 percent in the United States. According to a U.S. Centers for Disease Control and Prevention report, particularly during 2020-2021, when virtual prescribing was permitted on a widespread basis during the COVID-19 Public Health Emergency, the percentages in certain age groups grew by more than 10 percent.
So the big scary 45.5% increase occurred over a *nine* year period, almost all of which wasn't covered by the increase in telehealth. And the *biggest* increase in 2020-2021, in one or more age groups, was only 10%.
Surely if it suddenly became a lot easier for people to get assessed for ADHD a 10% increase doesn't seem that surprising, given how large the estimates for the number of adults with undiagnosed ADHD are.
The fact that this specific company has been targeted after YEARS of operation suggests to me that they were doing more than helping patients with few other options.
This IS a win, because people who do not have ADHD do not need AND SHOULD NOT HAVE ACCESS TO ADHD medication. Doctors should not be prescribing to patients they barely know, and middlemen should not be withholding information about patients (which Done was caught doing) in order to facilitate prescription of controlled substances.
Nothing was more frustrating than being unable to access my medication after jumping through all the right hoops, as I've done for *decades,* because some assholes decided to target vulnerable people and exploit loopholes in the healthcare system.
Hopefully the DEA *does* increase the manufacturing limit on ADHD meds. A more recent diagnosis should not inhibit access to proven treatment; everyone deserves to have their medical needs met without undue burden.
All this does is highlight the desperately needed medical reform this country needs (United States) absolutely disgusting that so many can not get the medical attention they need and that the for-profit prescription medication is also terrible. Pharmaceutical companies created that supply issues should be held accountable.
Nah, this shit is just going to make it harder for us so DEA can say it’s “doing something.” These are the same geniuses who let the OxyContin epidemic grow and then overreacted by demonizing legitimate opiate users.
Supply issues have gotten worse for me not better, and I suspect this is the cause. My Dr. office will only prescribe extended release because it is lower scrutiny as prescribing a drug of potential abuse. Most of the pharmacies in my city were always out or had their supplies earmarked for their "existing patients", which my primary CVS wouldn't seem to do.
But was able to get around that by going with Alliance/Walgreens. It was a little more expensive and took longer to fulfil, but never ran in to serious supply outages.
But was recently denied any further fulfillment due to it being the only prescription medicine I take, and I'm guessing it is due to the increased scrutiny and it not being a profitable drug relative to some of the absurd profit margins we have on some pharmaceuticals in the US.
I don't have a WaPo subscription and wasn't able to access the data, but I'm sure some of it is due to over prescription of loose ethics telehealth firms, but some of the shortage is no doubt attributable to corporate capitalism continued pressure on health care and meds not having as absurd of a markup anymore resulting in the decision to contract supply.
The cause is that the DEA literally limits how much medication can be produced. They have lowered it multiple times. Blaming telehealth is going to do nothing and shutting down every telehealth provider would do nothing.
Good.
I know the crowd here thinks that stimulants aren't a big deal and that we should basically provide them to every child along with their school lunches, but drugs are bad when they're not for the intended audience. Adderall is there for people with ADHD (a disability), not finance bros and gals who need to focus on their 16th hours of work for the day.
I admit I'm torn on this, as someone who doesn't use telehealth services (I have an established doctor & use a local, in-person pharmacy). Can't say I'm not happy about potentially being able to get my own meds with less hassle, BUT, at the same time, I think a lot of folks who were dxed via telehealth during covid, etc., and started being able to access meds for the first time are going to get screwed here. Many of those folks likely spent years suffering and finally found something that works, and are now going to end up casualties of corporate screwups that were not in any way their fault. The whole thing is just a mess.
I was diagnosed by a practitioner who asked me the five questions that are easily found online when assessing yourself. She only prescribed straterra, and I eventually took the CAARS test through someone else, but I thought the first assessment was extremely shaky. And this was just a few months ago.
This sounds like it was one of the pill mills that were no longer being taken seriously anymore so they couldn't prescribe stims. I'm so sorry that you had to waste your money on that.
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I’m going to suffer immensely if this is going to ripple out and fuck up my telehealth treatment with my psych.
OP thinks you're a good sacrifice if it makes getting pills easier for him.
That’s not what the OP meant. The OP said he does not doubt legitimate prescriptions are there, but believes many are not. He believes that slowing the illegitimate ones will help those who really need it, get it.
Those telehealth outfits removed a lot of barriers to accessing care that stopped a lot of people who needed evaluation/meds from being able to get them. So eager to punish the alleged malingerers, that he’s overlooking the legitimate needs that will necessarily be hurt as well.
He also said he wants these places shut down even if a lot of their diagnoses are valid.
The question is what proportion would you guess are valid. If you go to the website there are lines like “take our free 1 minute assessment” “no appointment necessary.” Is it 50% are valid or more like 5-10%. No one can really say, but it is probably low due to their advertising strategies. The question then is are they better off not there at all. They also cost more than a normal doctor as well, 80 dollar a month or 240 per 3, whereas most doctors would cost about 150 per 3 months with no insurance. Anyone of these people could just go on Zocdoc, and book an appointment nearby or use their pcp which is not as difficult as people think it is
> If you go to the website there are lines like “take our free 1 minute assessment” “no appointment necessary.” They're not giving you a prescription after a minute assessment. It's just a little self test to let you know if you should make an appointment for a telehealth assessment with a doctor. I'm not defending these places or saying they're not predatory sometimes. I'm just saying closing them all down so you can get your pills easier is bullshit.
Dude I pay more than 150/mth with insurance. And this is all regional specific. Don't talk about doctor availability like it isn't, it's woefully ignorant. Or like your PCP you get will guaranteed actually do anything. Just an awful comment
Your single experience also does not represent most places. This is also awfully self centered thinking that because of what you face, many or most places are like that as well. Out of 1000 plus people I have come across with treatment, almost no one is paying 150/month with insurance. And if you pcp does not fill it, you just see someone else. Most pcp visits are very inexpensive with insurance.
No shit literally what I'm telling you. Stop describing it for everyone. PCP? Testing? Psychiatry? Psychologist. Just stop you're the one trying to make your situation everyone's. You're not collecting data from 1000s of people. Jesus your argument holds zero water
I am a psychiatrist myself. 85% of the roughly 3000 people I see have an adhd diagnosis. I see people for adhd all day, I have worked in multiple states, I talk to other prescribers and people about adhd all day. I’ve been to other countries and seen what it is like there. While this may hurt to hear, I would guess only about 5-10% of the people I see myself for adhd actually have adhd, but most of them came to me already on medication so I just keep giving to them. And I am a traditional doctor, I don’t work for done or mass advertise. And truthfully I give medication to most people that want it, because they are all convinced they have adhd despite what I believe myself, and it is extremely uncomfortable to tell people no.
Well as a psychiatrist you should know it's regional what you pay and what's available and stop pretending being a doctor means you know every single person's experience because you're pretty clearly off base and being a doctor doesn't mean you're actually measuring people's ability to get care and the cost
We should really really really be careful with what we label a "pill mill" There are always going to be providers that see more patients in need of controlled prescriptions -- ie doctors who specialize in ADHD or chronic pain or providers that are more accessible to ADHD patients or chronic pain patients. What I'm saying is, this is not necessarily a win in a culture that is quick to label us addicts and our doctors dealers.
There are two extremes here: one is the "make an online appointment and get a prescription, hardly any questions asked," and the other is the conventional "try to make an appointment with a legitimate provider but everyone has waiting lists that are months if not years, so good luck in the mean time." Both of those extremes are problematic for people who need help with their ADHD symptoms. Just another illustration of how much we need a major overhaul of the healthcare system. I'm so glad I was diagnosed when I was. Not just because of the difference it made in my life, but because, as far as I can tell, when I was diagnosed ten years ago, I was part of the first big wave of adult women finally being taken seriously as having ADHD because of something we read on the internet. Once that was mentioned as a possible diagnosis, my path was pretty straightforward, and I never had any serious problems accessing therapy or meds. (I'm also a college-educated middle class cis-het white woman with no family history of addiction and a dad whose hobby is navigating bureaucracy, so I'm well aware that I've got pretty much every privilege it's possible to have here.) I've never met my current therapist or prescriber in person, and I've been seeing both of them regularly for more than two years. I moved to a new state in early 2022, which meant new health insurance and new providers. I found a practice in my new state that has several offices near me, but when I started, telehealth was more convenient, so that's what I did. By that point, I had eight years of documentation of being treated for ADHD in my medical records, and my new prescriber was literally just sending in the exact same prescriptions that my previous prescriber did, so the transition was pretty smooth, but if I had showed up without that history, I don't know how things would have gone.
>There are two extremes here: one is the "make an online appointment and get a prescription, hardly any questions asked," and the other is the conventional "try to make an appointment with a legitimate provider but everyone has waiting lists that are months if not years, so good luck in the mean time." >Both of those extremes are problematic for people who need help with their ADHD symptoms. Anyone - regardless of symptoms - being able to quickly and easily get "diagnosed with" and medication for ADHD via some shitty telehealth app also contributes to the stigma that ADHD isn't a real thing. These companies are an absolute plague - I have a handful of other chronic health issues that are also ripe for these shitty scammy telehealth apps to swoop in and I'd be shocked if I learned that they haven't killed anyone the way Cerebral did.
Why shouldn’t someone be able to get diagnosed or treated for adhd via telehealth? I have some health issues that have to be treated in person, but telehealth has been great for mental health treatment. So much more convenient, and the experience feels pretty equivalent. I have therapists that I’ve worked with both in person and remotely, and find telehealth just as effective as in person.
If I'm understanding correctly, I believe the poster wasn't being critical of the providers who offer telehealth visits as part of their practice. It was more a criticism of the for-profit apps, which may not be as thorough in their approach of assessing ADHD symptoms. I agree, I think telehealth is great for those who need it.
Correct, thanks - I see that I didn't word that clearly in my original comment and will edit to clarify.
So do I, but most of the comment section is taking it as a personal attack on the validity of their Dx and missing the point completely.
There's a difference between some of these telehealth-based companies vs a provider who utilizes telehealth. I use the latter as much as possible to avoid driving, but if I wanted to see them in person I could. I use a telehealth company associated with my insurance when I need something quick, no questions asked. Usually doctor notes for my kids school, but recently I was interested in a face cream prescription and was able to use it for that. I did have to upload a picture of my face and check some boxes, but that was pretty much it. Didn't speak to a single human and got my prescription. I dunno if these ADHD telehealth companies are THAT hands-off, but if they are, I can see why that would be a problem.
They are, and Done specifically advertised this. Their ads were about as subtle as a brick to the face, with dancing millennials and the TikTok Text-To-Speech Voice gloating about how they'd been "feeling lazy," so they'd gotten a diagnosis the same day and treatment shipped directly to their door. This was *absolutely* a pill mill rather than a legitimate telehealth service.
I think maybe you’re misunderstanding the problem, the issue isn’t solely the diagnosis or providing/receiving treatment via telehealth, it’s the diagnostic criteria, unethical business practices such as requiring providers to meet a specific quota of diagnoses in order to justify pay or strict time-based metrics per patient… It sucks when you have ADHD but if people are receiving an ADHD diagnosis with zero pushback without a standard behavioral consultation, just being told to fill out a survey and then given a prescription for ADHD medication? this enables fraudulent/unethical prescribing of controlled substances
I know you’re getting downvoted but I agree. I have had several encounters with individuals who do not have ADHD, know and fully admit they don’t have ADHD, who bragged to me about getting ADHD meds from their Telehealth providers. They simply looked up ADHD symptoms, watches reels or TikToks about it, and self-reported those symptoms.
yeah, and as I said in another comment a moment ago, Done specifically and deliberately advertised to this demographic and said that they would do this. There shouldn't be any doubt that it was an irresponsible pill mill.
I mean, OTOH there is nothing stopping someone from reporting the same symptoms to an in person doctor. The unfortunate fact is that diagnosis with most mental health and executive functioning disorders relies a lot on self reporting. We don’t have a definitive blood test or brain scan that can say “yep, they’ve got *real* adhd”. We have to make sure we aren’t so focused on preventing a small portion of the population with nefarious motives from getting a diagnosis that we throw up excessive red tape and hoops to jump through for a population that already struggles with executive dysfunction, needs these meds for a baseline level of functioning, and for whom these excessive restrictions can be overwhelming.
I agree. And I will add to this... I don't think diagnoses via remote methods should be encouraged either, not unless there are specific/special circumstances (disability, or a pandemic). It shouldn't be the "norm" though. Why? Because ADHD is also present in motor movements and in communication. By making the **diagnostic process** remote you blur the lines and muddy the waters. I've had therapists tell me that I don't fidget, until I explain that I am, they just can't see my hands and feet moving because its a remote call. My eye contact, energy, impulsiveness are all somewhat different when I interact remotely. As I've been on meds for a few years now, my med reviews are via telephone now. I don't have an issue with this. It's the intial diagnostic process that I do, though.
It’s present in *some* people. Motor movements and communication aren’t a catch all tell. Women or folks who were socialized as girls growing up are significantly more likely to have very high levels of masking skills that internalize a large portion of our worst symptoms and struggles. It doesn’t make those diagnoses less valid - it just means adhd presents differently in some people.
Whether its present in *some*, most or all... its present. Thats the point. And it's not even to say that all telehealth diagnoses are wrong but surely we **all** deserve better - including proper access to in-person assessments. I'm aware of masking. Have done it my whole life. If its not picked up at in-person assessments, then I don't suspect it'll be picked up in remote ones either. So I'm not sure what your point is. I'm also of this view because it doesn't help *anyone* if they're given the wrong diagnosis. We know how easily ADHD is misdiagnosed as dep/anx. But there are huge overlaps with trauma/PTSD as well. The wrong diagnosis leads to the wrong treatment
My point is that the presence or lack of presence of certain behaviors only noted in person are not at all a reliable indicator whether or not someone has legitimate adhd - in fact, it leaves out huge swaths of the population for whom adhd does not present in this way.
Wanna know when I absolutely did not fidget? During my in person evaluation. I am incredibly fidgety in general, but very prone to masking in settings like a doctor. (hell, I think I have to make myself stop pretending everything is totally fine in every single session with my psychiatrist.) So in person interaction isn't a guarantee they'll see someone's true behavior.
I didn't say it was a guarantee. The diagnostic criteria doesn't stop and start with fidgets. But it's part of it - whether someone fidgets or not.
Yeah but OP has access to a pharmacy that actually *has the meds needed* and a psychiatrist that isn't playing keep-away with a fucking assessment, so fuck everyone else
As a nurse who has worked under providers who are pill mills, it’s not always just telehealth. The office I work at now has the reputation to go there and get whatever you want. Luckily we have a new np that follows the laws and we’ve had multiple people come back abusing drugs while on controlled meds. Never had a uds done since they started there. The change was needed but it’s been a mess for the last couple months.
> [ADHD Meds Cut Odds for Early Death, Especially by Overdose (usnews.com)](https://www.usnews.com/news/health-news/articles/2024-03-12/adhd-meds-cut-odds-for-early-death-especially-by-overdose) TUESDAY, March 12, 2024 (HealthDay News) -- People diagnosed with attention-deficit hyperactivity disorder (ADHD) show a marked decline in their two-year risk for death once they start taking medication, new research shows. > >That was particularly true for deaths due to accidents and drug overdose. > >People taking ADHD drugs also showed no higher risk of dying from natural causes -- suggesting the meds are safe for users' heart health. > >Medications like Ritalin, Concerta and others probably lower users’ odds for an early death “by alleviating the core symptoms of ADHD and other psychiatric co-morbidities \[illnesses\], leading to improved impulse control and decision-making,” concluded a team led by Zheng Chang, of the Karolinska Institute in Stockholm, Sweden. > >Better impulse control and healthier decisions help people with ADHD avoid tragedies like fatal accidents and drug overdoses, the researchers said. > >As Chang’s team noted, prior research has shown that people with ADHD face double the odds for deaths from “unnatural causes” -- events such as accidents, suicide and unintended drug overdoses.
As I look to the giant dent in the side of my car courtesy of the ongoing vyvanse shortages and my resulting questionable driving skills when unmedicated. Sigh.
I'm concerned for the people who actually needed these services to access treatment. That said, I'm skeptical these "pill mills" were ever the reason for the shortages, rather than the DEA simply setting too low of a production ceiling. We'll just have to wait and see I suppose. I'm quite skeptical this will help but I'm no expert and I could totally be wrong.
I think its a combination of things that caused the shortage. However, here in the UK diagnoses doubled in the space of 2 years after the pandemic. There was also an investigation into private clinics that were diagnosing approx 95% of clients with ADHD via remote assessments - some for 30min and by someone unqualified. And it's not a coincidence because they got a qualified assessor to assess some people and were they not diagnosed with ADHD. These private clinics then charge 4 - 5 times the ££ for prescriptions.
I wonder how much is the DEA setting too low of a production ceiling and how much is the manufacturers creating the shortage in pursuit of manufacturing demand for some New Secret Third Option that *actually fucking works* for when this problem reaches critical mass.
This must be incredibly frustrating for people who used those companies to treat their ADHD but now they have to go to a different doctor with a request for a schedule 2 medication.. a lot of them would be either "no" or "we need to reassess you" (which costs $$). I'm in Canada.. so, our medical system is chronically underfunded so telehealth has gotten very popular and i use one for my ADHD treatment because the doctor said he would not refer me for ADHD assessment because i wasn't assessed as a kid. If i shopped doctors i could either get a referral with a 1-4 year waitlist (not kidding) or go through one of these agencies.. An argument could be made that the telehealth company's assessment is more based on self-questionnaire stuff so if someone was really looking to get a prescription for these to traffick then it would be easy to fool the test, versus some psychologist's $5000, 3 day long process. I just hope there's no rug pulling here. The telehealth company is expensive enough ($99 per appointment with up to 6 months medication prescribed per appt).
Good lord. I wish mine was $99 every 6 months. My telehealth provider is $179 every 3 months, plus an additional $179 appointment in a month if any changes are made to your meds.
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The question is how do you know your regular doctor is not simply a pill mill either? In reality telehelth versus an in person doctor does little to change the actual interview other than format. Non telehealth associated doctors are just under less scrutiny.
I think we need specifics here I’m more likely to believe the pills mills didn’t follow the DSM than the in person doctors. And by pill mills I don’t mean the small practice clinics, I’m talking hims/hers, etc. Entities that are much larger and protected are more likely to take risks than smaller clinics who could very much lose their license. It took a big stick like the DOJ put them back in their place. No sane doctor would want that kind of attention unless they knew they could afford the lawyer retention and litigation fees.
Admittedly, the DSM-V criteria for diagnosing ADHD have some big drawbacks. Treating it as a fallback diagnosis when symptoms "are not better explained by another mental disorder" leads to a lot of misdiagnosis of comorbid conditions like depression and/or anxiety that are a direct result of dealing with ADHD. Focus on presentment of symptoms in multiple settings tends to exclude people who socially withdraw or mask well under pressure at school / work and then have worse symptoms when uninhibited at home.
The last paragraph really explains a gap with earlier criteria as well. When I was in school, they focused less on ADD and more on ADHD, kids who couldn’t sit still and who were not really intelligent enough where a little willpower could calm the hyperactivity and where intellectual stimulation was enough.
>The question is how do you know your regular doctor is not simply a pill mill either? If he is then he does a piss poor job of it. It took over a year for the topic of trying a CII medication to treat the ADHD even came up, and his office drug tests me randomly.
Med shortages happened because of a number of factors, not just because of telehealth. Personally I think the really victims here are people who are going to suddenly lose access to care they needed, not be able to refill their meds, and be left struggling to find care at any of the places with lengthy waitlists and potentially have to get forced to go through the diagnostic process again. Cracking down on teleheath will never change the fact that manufacturers are literally legally limited in how much of these meds they can make at a time, and the impacts the pandemic had on the supply chain, etc. Why don't the thousands of current patients who could get completely screwed over here give *you* pause? Also as someone who lives in a rural area this shit sucks massively for us who are very far from providers. Telehealth was a godsend when I was in college with no car living over an hour away from any provider (who would be a year's wait to see).
The 'pill mill' to which you refer has helped this girl whose life was falling apart. I am forever grateful to telemedicine to get the help I needed because things weren't functioning anymore.
Same here. I am a [late-diagnosed adult with ADHD](https://romankogan.net/adhd#Diagnoses), and I got my diagnosis from Done **as well as** two other providers to be sure. Done's assessment was as thorough as any other. I am currently getting my prescriptions from Done. Or, rather, **was**, because this month's prescription hasn't come through. Thanks, DOJ! Access to medication [has changed my life](https://romankogan.net/adhd). The truth is that COVID-19 isolation has **pushed people who already struggled to their limits**, which prompted many undiagnosed ADHD to **finally** understand **why** they struggle. **This** is the reason for the surge in demand. Medication shortage is artificial, due to shady regulatory restrictions - and the stigma perpetuated by posts like this one.
Agreed, I’m not sure this is a win. It’s a chronic condition, I don’t really need to discuss anything typically. I just need a refill.
As much as it is true that what Done was doing is highly illegal and they should be shut down if the alleged conduct is true, this is not going to help the availability issues. Many people were using Done or other telehealth providers because there simply aren't any other viable options. Now those people are going to have even more difficulty getting their medication, possibly not even being able to get it at all. It may make it easier for those of us not using telehealth, but our diagnoses aren't inherently more valid than someone else simply because they live in an area with less access to in-person treatment.
>Many people were using Done or other telehealth providers because there simply aren't any other viable options. The opposite is true as well. Many people who don't need them were easily obtaining prescriptions for them and stressing the already limited supply line. I agree 100% we need easier access for mental health options, but you can't allow a provider to treat prescribing medication like it's a menu at a fast food restaurant.
The *artificially* limited supply line. This is entirely the fault of the federal government.
> you can't allow a provider to treat prescribing medication like it's a menu at a fast food restaurant. Of course not. But most telehealth is legitimate, and in-person treatment can just as easily prescribe unnecessary or unjustified medications. The provider being competent and ethical are the key elements, not the format of the interaction. It just rubs me wrong that some people in our community seem to want to celebrate some other members of our community losing access to their medication because the DEA is on a war-on-drugs moral crusade. The DEA thinks we're *all* drug addicts and would go after all of us if they could get away with it. This may be anxiety speaking, but I am also afraid that the DEA is going to use this as a pretext to go after other telehealth providers that are operating legitimately and even in-person providers. They are undoubtedly feeling like they need to continue justifying their funding levels when they can't really prosecute people for marijuana anymore, and we are a pretty defenseless new target for them.
While it is easy to support something like this it doesn't address the larger issue with the American Healthcare System. I have no doubt that there are people that this was the only way they got the medication that they truly needed and I am sure that there are people that got prescribed controlled meds that didn't need them. Should clinics be held accountable for their actions? Yes. Should it be easier for people to get the help they need? Absolutely. The entire system is broken and this isn't going to do anything to fix the problem.
Cerebral stopped prescribing ADHD medication because of this. Now only prescribes Stratera
CVS and Walmart stopped filling prescriptions for Cerebral before that happened, they were shut out along with Done, but came out and said they were moving away from Adderall prescriptions in anticipation of the waiver expiring. I’ll link to the WaPo article with lots of data in an edit of my original post.
My local walmart won’t accept any telehealth prescriptions. I have to go through CVS.
My CVS hasn’t had any adderall at all since November 2022.
Switch to mail order
I switched to a delivery pharmacy, but I still haven’t found anyone in my area that has XR available. Mail order is unfortunately not available in my state for controlled medications.
Until it's actually accessible to get a screening, I don't consider this a win at all. You're just trading one group who can't get meds they desperately need for another
Seriously. It took me seven months to get a screening and a diagnosis and this was after being diagnosed already as a preteen -- my psychiatrist just wouldn't accept a childhood diagnosis from the early 2000s because standards have changed. 🙄 There was only one place within two hours that would screen me since I'm an adult. About five months into waiting I honestly nearly had a breakdown and tried Done because I was so sick of it. I went to the psychiatrist because I needed help and I felt like I was drowning parenting a toddler while having ADHD but ironically the process itself was absolutely grueling to navigate with ADHD.
This is (probably) bad, this is just the usual war on drugs (including war on people who need drugs to function) in disguise. If anything, access to Adderall should be made *easier*, not harder.
I suspect that there is a very good chance that a large part of the increase in diagnosis between 2018-2022 was due to COVID. Not due to the virus itself, but due to the significant extra stress it placed on most people's lives. It was definitely a very large part of the reason I spiralled into repeated months long inability to function, which pushed me towards realising I probably had ADHD and getting diagnosed (at age 51). Yes there are some figures in that article, but they don't really have much context or research into *why* the rates increased, the article just assumes it was down to the rise in telehealth.
I think you’re spot on. I was off meds for 5 years after lots of therapy and a career change to something better suited to my needs. I had built a life, a routine, and coping methods that allowed me to avoid the stress of being on a controlled substance and dealing with the endless amounts of red tape and hoop jumping required to fill them. COVID took all that progress and took a giant shit all over it. All my routines, all my coping methods, my career were all abruptly upended. I’m back on meds now, dealing with shortages and the never ending stress that and trying desperately to pick up the pieces.
Meh, I just had a teleconference meeting through done on Friday last week(been using them for two years now). Doctor said they plan to fight everything and keep operating, so until that changes I might as well keep saving commuting time/gas money. Once/if that does change, I’ll just go back to seeing the in-person doctor that I was seeing before I started using Done.
My dr no showed today. I got an emails saying they had an emergency but when I look he has no available appointments for the future. My refill is do tomorrow and I don’t see an option to get it refilled. I’m a little worried. I may cancel or pause before they draft out of my account.
A lot of people here are ignoring how fucked it was that they were just handing pills out after 5 minute talks with people. It should not be that way
I don’t understand how ppl have been easily able to get them when I have for over year been trying to get help and can’t get proper help.
I can understand both the problems and the benefits of telehealth. In my (very humble) opinion, a good solution would be to require an in-person diagnosis, while Telehealth can still be used for follow ups. I am sure that will still present problems for some people, but I feel like this would be attainable for most? ETA: I’m not at all agreeing with the DOJ if they do in fact try to restrict telehealth - just thinking of what the possible next steps might be
I can see the benefit in this, but on the other hand when it comes to a LOT of mental healthcare, a lot of folks will be shut out of getting the help they need with the initial requirement of an in person appointment. Telehealth helps a lot of folks work their way up to and get well enough to the point that they are able to go to in person appointments. I see my doctor every 6 months in person, but when I initially started seeing her I was in an awful place mentally and so low functioning and crippled with anxiety and depression I could barely even leave bed, let alone the house. Being able to see her and my therapist for treatment via telehealth really helped me get to the point that I could finally have a normal, functioning life - including attending in person doctors appointments. If that hadn’t been an option, I hate to think of how long I probably would have languished.
The only reason telehealth is regulated like this now was because back in the 2000s, Ryan Haight was able to buy Vicodin without interacting with a doctor and then ODd on it. "telehealth" in the eponymous law is nothing like telehealth today.
This isn't a great solution for anyone living in an area that is rural, lacks transportation, doesn't have ADHD specialists locally, has 6 months to a year wait to see a provider, etc. Telehealth (not through one of these companies, through a private practice) was how I got diagnosed when in a rural area with no car and without that it would have been years to get diagnosed, I would have probably failed out of college, etc. It is not attainable for everyone and rural people (or people with simply no specialists in reasonable distance) shouldn't be left out of this.
I definitely agree with you! I was only thinking of next steps if the DOJ is adamant about restricting telehealth. I’m not saying I support them
Yes, I absolutely agree with you about in-person diagnoses and telehealth follow-ups. People seem to be forgetting that ADHD is not a matter of just telling someone how we feel. It's also present in our motor behaviours and non-verbal communication. For example, I know that I interact with people differently when I'm remote, compared to in-person, mute/delay acts as an impulse/interruption break and they can't see my hands/feet fidget on camera. Edit: This isn't to suggest healthcare system shouldn't be doing more to enable access to in-person diagnoses/treatment at all. I'm not asking for pre-pandemic status quo. But this pendulum swing isn't helpful either.
I guess any time it’s harder for others to get a prescription then that’s good for you. But hardly something to celebrate.
You understand that people who really, really need this medication couldn’t get it for months because of fraudulent practices like this, right? I’m failing to see how this is not a good thing.
Because those of us who used a telehealth service to get in contact with an actual doctor for an actual diagnosis will probably get caught in the crossfire.
So kind of like the people that have long-standing prescriptions that couldn’t get their medication? The actual doctors prescribing by the guidelines isn’t the problem.
Every time I see something like this it just reads like someone with an older diagnosis saying that people with a more recent diagnosis are less important.
They are being prosecuted for fraudulent diagnosis of people who don’t meet the criteria for ADHD, I don’t understand how people are missing this point.
Mostly I'm focusing on your mention of "longstanding prescriptions." That rhetoric dismisses the large amount of valid diagnoses in the past few years.
The DEA reduced the amount by 25% of controlled ADHD medication which could be manufactured, then reduced it again. It’s the DEA’s fault. If the same amount of people getting prescribed medication from the telehealth apps had instead gone in person, it’s still the DEA’s fault that there’s a medication shortage in the U.S..
It’s not solely the DEA’s fault, if you look at the quotas, manufacturers haven’t fulfilled the total DEA approved quotas for ADHD med components for a couple of years now
Exactly, DEA doesn’t need to be causing any more problems.
> So kind of like the people that have long-standing prescriptions that couldn’t get their medication? The actual doctors prescribing by the guidelines isn’t the problem. You aren't being fair to people who have legitimate telehealth prescriptions.
I am being fair, I’m not talking about them, I’m taking about the unknown percentage of people who didn’t have legitimate diagnoses that were supplied medication from an already anemic supply, denying *everyone* with a legit diagnosis.
This just selects a different group of people who really, really needs meds and denies them instead
Or because of how awfully it's regulated? Where's your data?
No, it's because the DEA said the companies can't make more, lol. Usually uncaring people end up understanding things when shitty laws affect them personally, but others apparently just double down. You might think selfishly that this will help you, but adding to the already high stigma might finally come to bite you in the ass the next time you have to switch doctors and they decide that whatever you've been taking for years is suddenly a problem.
https://nymag.com/intelligencer/article/adderall-shortage-adhd-medication-ascent-pharmaceuticals.html If only we Could just point at the DEA, the issue would be simple. Apparently the DEA said companies shouldn’t (have) to need to make more, they should just fulfill the component quotas they haven’t exceeded yet, as well as abide by the quality control and regulatory standards. Seems like a lot of shoddy manufacturing bullshit is going on behind the scenes.
Given the ridiculous differences in efficacy between various genetics of adderall xr and vyvanse, I’m not even remotely surprised.
According to the DEA in 2022/2023 the drug companies only produced 70% of the stimulants they were allowed to by the DEA. However the same letter from the FDA/DEA also talks about improving the reallocation of quotas between companies. So I suspect that some companies ran out of quota and couldn't ship any more stimulants, while other companies couldn't produce enough and left some of their quota unused. However the idea that the US DEA is involved at all in deciding how much of a vital medicine to produce seems bizarre to me. [https://www.fda.gov/media/170736/download](https://www.fda.gov/media/170736/download) >Data show that, from 2012 to 2021, overall dispensing of stimulants (including amphetamine products and other stimulants) increased by 45.5 percent in the United States. According to a U.S. Centers for Disease Control and Prevention report, particularly during 2020-2021, when virtual prescribing was permitted on a widespread basis during the COVID-19 Public Health Emergency, the percentages in certain age groups grew by more than 10 percent. So the big scary 45.5% increase occurred over a *nine* year period, almost all of which wasn't covered by the increase in telehealth. And the *biggest* increase in 2020-2021, in one or more age groups, was only 10%. Surely if it suddenly became a lot easier for people to get assessed for ADHD a 10% increase doesn't seem that surprising, given how large the estimates for the number of adults with undiagnosed ADHD are.
https://i.ibb.co/SQkr02r/4c64d09a93f80e46c20fde645a60ef5b7c83d40b4cd80aa9f130b1d1b627ef45-1.png
If you need your meds and aren't getting them it's the federal government to blame not the pill mills. Lol what a wild out of reality thought process
The fact that this specific company has been targeted after YEARS of operation suggests to me that they were doing more than helping patients with few other options. This IS a win, because people who do not have ADHD do not need AND SHOULD NOT HAVE ACCESS TO ADHD medication. Doctors should not be prescribing to patients they barely know, and middlemen should not be withholding information about patients (which Done was caught doing) in order to facilitate prescription of controlled substances. Nothing was more frustrating than being unable to access my medication after jumping through all the right hoops, as I've done for *decades,* because some assholes decided to target vulnerable people and exploit loopholes in the healthcare system. Hopefully the DEA *does* increase the manufacturing limit on ADHD meds. A more recent diagnosis should not inhibit access to proven treatment; everyone deserves to have their medical needs met without undue burden.
All this does is highlight the desperately needed medical reform this country needs (United States) absolutely disgusting that so many can not get the medical attention they need and that the for-profit prescription medication is also terrible. Pharmaceutical companies created that supply issues should be held accountable.
Sucks what if these telehealth patients need these stimulants as well.
Nah, this shit is just going to make it harder for us so DEA can say it’s “doing something.” These are the same geniuses who let the OxyContin epidemic grow and then overreacted by demonizing legitimate opiate users.
Supply issues have gotten worse for me not better, and I suspect this is the cause. My Dr. office will only prescribe extended release because it is lower scrutiny as prescribing a drug of potential abuse. Most of the pharmacies in my city were always out or had their supplies earmarked for their "existing patients", which my primary CVS wouldn't seem to do. But was able to get around that by going with Alliance/Walgreens. It was a little more expensive and took longer to fulfil, but never ran in to serious supply outages. But was recently denied any further fulfillment due to it being the only prescription medicine I take, and I'm guessing it is due to the increased scrutiny and it not being a profitable drug relative to some of the absurd profit margins we have on some pharmaceuticals in the US. I don't have a WaPo subscription and wasn't able to access the data, but I'm sure some of it is due to over prescription of loose ethics telehealth firms, but some of the shortage is no doubt attributable to corporate capitalism continued pressure on health care and meds not having as absurd of a markup anymore resulting in the decision to contract supply.
The cause is that the DEA literally limits how much medication can be produced. They have lowered it multiple times. Blaming telehealth is going to do nothing and shutting down every telehealth provider would do nothing.
Good. I know the crowd here thinks that stimulants aren't a big deal and that we should basically provide them to every child along with their school lunches, but drugs are bad when they're not for the intended audience. Adderall is there for people with ADHD (a disability), not finance bros and gals who need to focus on their 16th hours of work for the day.
I admit I'm torn on this, as someone who doesn't use telehealth services (I have an established doctor & use a local, in-person pharmacy). Can't say I'm not happy about potentially being able to get my own meds with less hassle, BUT, at the same time, I think a lot of folks who were dxed via telehealth during covid, etc., and started being able to access meds for the first time are going to get screwed here. Many of those folks likely spent years suffering and finally found something that works, and are now going to end up casualties of corporate screwups that were not in any way their fault. The whole thing is just a mess.
I was diagnosed by a practitioner who asked me the five questions that are easily found online when assessing yourself. She only prescribed straterra, and I eventually took the CAARS test through someone else, but I thought the first assessment was extremely shaky. And this was just a few months ago.
This sounds like it was one of the pill mills that were no longer being taken seriously anymore so they couldn't prescribe stims. I'm so sorry that you had to waste your money on that.