This is not medical advice! This is metamedical advice. I am not discussing facts, I am sharing opinions and strategy.
ADHD sucks. Executive dysfunction makes everything harder than it needs to be. Small doses of stimulants (10-30mg of dextroamphetamine, a lightdose) can be effective for improving executive dysfunction and quality of life, but most stimulants proven effective for enhancing incentive salience are schedule II drugs - amongst the most restricted substances in America.
Schedule 2: cocaine, meth, oxycodone, Adderall, Ritalin, and Vicodin
So, what is an ADHD person to do?
Play the game. Get the drugs. Live your best life.
The high level strategy:
- understand the risks a doctor may perceive in prescribing you stimulant ADHD medication
- do not admit to using illegal drugs (cannabis, especially!) - or to using legal drugs without a prescription EXCEPT...
- "I have tried this, and I have observed it helping me" -- takes out SO much guesswork of the process, and can be helpful.
- present orderly, in such a capacity as to minimise the relevance of the risks, especially avoid perception as an individual with high risk of drug abuse
- tell a story indicating you understand the risks and rewards of ADHD medication, and consider them an important tool for overcoming clear and present challenges in your domestic life, social life, and professional life.
- ask for your doctor to help support your growth, by fortifying you with helpful medication.
- repeat until you find a combination of medication/doctor that works for you!
- First and foremost: drug abuse. Folks take lots of pills - and have bad times. If you take 3x-10x your recommended dose, it might be "fun" - but it will also do bad things to your brain, your heart, and probably other parts of your body, as well. Doctors really do not want to give "drug abusers" more drugs. Lots of folks would love to have some Adderall, but doctors do not want to enable this.
Medical doctors also completely lack the ability to differentiate between drug abuse, and self medication.
- If you admit to smoking weed, they will be nervous.
- If you admit to self-administering HRT, they will be nervous.
- if you admit to taking psychedelics, or MDMA, they will be nervous.
Save yourself TONS of trouble, and manage your MD. Don't overshare. I'm sorry. It's the way things are.
There is official guidance from the DEA and FDA contraindicating the concurrent use of cannabis and adderall - the result is emails like this one, which a friend received recently:
Our state regulations require that we ask the following questions when a patient is requesting a refill for a controlled substance.
Are you taking any other controlled substances other than the one that is being prescribed by your provider?
Are you using any illicit drugs?
Are you using Marijuana?
Please respond online or call the office. We will be unable to send your prescription request to the provider until these questions are answered.
Honestly, save yourself some trouble, and spare your doctors the burden of the truth.
The cost of failure is high, the systems byzantine, and the gatekeepers Problematic. Drug testing costs money, and they're unlikely to spend that money (or try and extort you into spending the money) unless they have "Probable Cause" to believe you're ie) selling your adderall pills to buy cannabis, harming yourself by taking a large number of pills concurrently, or demonstrating pathologies associated with polydrug abuse / addiction. They can't make you do anything - if they try, politely refuse, and find a new doctor.
- Second risk: some people aren't meant for speed. If you have high blood pressure, high resting pulse rate, severe anxiety, bipolar disorder, cyclothymia (bb bp), or mania - find other ways, besides inducing the release of monoamines. It's possible selective MAO-B inhibitors - like Rasagiline - may be an almost-effective monotherapy.
This document is not medical advice. It's metamedical advice. I'm not going to go into much detail about the whys and hows of the contraindications of taking stimulants with these pre-existing conditions, but - reach out if this is relevant, and I may be able to expand or share further thoughts.
or:
What steps can one take to ensure they are perceived in a capacity that will produce the desired results?
You're "socially engineering" "Dr. Karen." Act like it.
Our hypothetical Dr. Karen is....
- a quarter mil in debt
- the proud owner of four Vera Bradley purses
- about to swap leases on her BMW
- married to someone who plays golf too much
- friends with rich white people
She spent 5-10 years in med school, learning bullshit dogma, and cramming an absurd amount of miscellaneous heuristics for the human body in her head.
She has a safe job, as long as she doesn't fuck up, by supplying a drug ring with pills, or having a patient kill themselves.
With this narrative in play, here are some heuristics to help ensure things work in your favour!
- Dress to impress. Wear a collered shirt, or blouse. It's dumb, but it helps - this an interview - not for a job - but for a license to possess schedule II substances.
- Bring notes. Have some idea for how the conversations are going to go. Think about what you're gonna say ahead of time. This is an interview.
- Take some deep breaths in the waiting room, and in between when you're taken to your visiting room and when your vitals are taken. If you're nervous, say so. "white coat hypertension" is real - and is very different than having high blood pressure or a high resting pulse rate. One visit, I read 140/90 and my heart was at 130bpm. At the end of the session, after securing my prescription, and coming out as trans, my vitals were taken at 110/70 and 65bpm. Doctors love to see this.
- Be a young white male. It helps, lol. Sooner you start this process, and the closer to "normal ADHD person" (suburban white boy) - the easier time you'll have.
- Know your story. Ideally, it's true. Make sure it's truth-y.
An example story, from my earlier forays.
"Yeah, I've been working a full time software engineering job for a few months, and discovering coffee isn't cutting it to manage my inattention and distractability. I'm having a hard time managing my days with 4 hours of meetings, and I can't afford to lose this job. There's a lot of flexibility that lets me apply my peak hours to get done the complicated stuff when I can, but I'm going for a promotion and struggling to manage my detail-oriented workloads, especially on days when I have lots of meetings. I was prescribed adderall XR 40s in highschool, and those made me feel kinda jittery and gross - I'd like to try taking two 10mg dextroamphetamine IR tablets a day, one at morning, and one with lunch, so I can be sure to fall asleep at 11pm every night, like I have been doing."
Making phonecalls to find a doctor, and being the right-amount-of-vulnerable with your doctor is hard but -
Reading between the lines of the most popular medical oath used for swearing in doctors, one can see the some of the incentives motivating their behavior. The quoted lines are copied from the relevant wikipedia article. The lines underneath are a quick summary / interpretation, for the purposes of this article.
TL;DR - they're on your side.
I swear to fulfill, to the best of my ability and judgment, this covenant:
They take this seriously.
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
They will follow best practices.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
They will try to be helpful, having an obligation to hear you out, believe your words, but avoid dispensing unnecessary medication.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
They will endeavour to be compassionate, to understand your situation, before dispensing medication.
I will not be ashamed to say "I know not", nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
They don't have to do anything they don't want to do; worst case they will recommend you to another MD.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
They theoretically have to keep your confidence, so you can tell them you do crimes n be gay - but this knowledge must be weighed as they dispense care.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
They are incentivised to see you succeed in the workplace, and will try to support your success if possible.
I will prevent disease whenever I can, for prevention is preferable to cure.
They will ensure you consider diet, exercise, and good habits (not smoking weed) - before dispensing ADHD medication.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
They take this seriously.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
They take this seriously.
From Wikipedia:
amphetamine is contraindicated in people with a history of drug abuse, cardiovascular disease, severe agitation, or severe anxiety
Addiction is a serious risk with heavy recreational amphetamine use, but is unlikely to occur from long-term medical use at therapeutic doses;
thanks to everyone who helped title / subtitle this essay!
68 votes from https://twitter.com/infra_naut/status/1364788471789989891
ad astra per adderall 42.6%
appropriate myths n how t 1.5%
u wouldn't DL a dopamine 33.8%
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