Nov 30, 2023 09:10 PM
(This post was last modified: Nov 30, 2023 09:20 PM by C C.)
https://www.thenewatlantis.com/publicati...out-uppers
EXCERPTS: Americans can’t find enough Adderall. In 2021 pharmacists filled over forty million prescriptions for the popular ADHD drug, a sixteen percent increase in just two years. But this explosion in demand, likely driven by lax telehealth prescriptions during the pandemic, has run up against available supply. Because Adderall is a controlled substance, its production is carefully limited by the Drug Enforcement Agency. Some patients now ration their pills or drive hours to fill their prescriptions. People who have taken Adderall daily since they were children find themselves struggling to operate without it.
Americans find it only too easy, by contrast, to obtain methamphetamine. Of the 109,000 American drug overdose deaths last year, a third were caused by psychostimulants, mainly meth. That’s a more than tenfold increase in a decade, making methamphetamine second only to synthetic opioids, principally fentanyl, in driving the overdose crisis. This is in part thanks to meth’s new abundance and cheapness — by one estimate, illicit wholesale prices have fallen nearly eighty percent since 2016.
In many ways, the shortage of Adderall and the bounty of meth are unrelated problems. They affect different people, in different places, and at different scales. But the drugs are also chemically similar....
[...] The return of meth in the mid-1990s could, of course, just be attributed to declining taste for cocaine, or to an accident of efficiency. What makes it interesting, culturally speaking, is that it was more or less simultaneous with the return of pharmaceutical amphetamine — and with the explosion in ADHD diagnoses.
Children have been diagnosed with the symptoms we now identify as ADHD for over a century. The 1968 second edition of the Diagnostic Standard Manual of Mental Disorders included “hyperkinetic impulse disorder.” In the third edition it was renamed “attention deficit disorder,” or ADD, with and without hyperactivity. Amphetamine was used for treating patients, although the frontline treatment was methylphenidate, better known as Ritalin. But medicating kids was both controversial and relatively rare. The early 1970s saw a massive dispute over the prescription of stimulants to children, despite the relatively small number of children receiving them, perhaps two hundred thousand.
Then, in the 1990s — by which time ADD had become lumped together with ADHD as a single disorder — diagnoses began to boom. In 1997, when the CDC first surveyed the prevalence, six percent of American children were diagnosed with ADHD. Today, the figure is ten percent. The reason for the change is not perfectly clear. It may have been increased public awareness and testing, or shifts in diagnostic criteria, or both. What almost certainly fueled the trend was when, in 1991, the federal government said that students with ADHD diagnoses could receive special education services.
For our purposes, though, the most noteworthy change is the 1996 approval of Adderall, an amphetamine preparation, for treating ADHD. That year, there were 1.3 million amphetamine prescriptions, mainly Adderall. Just three years later, according to DEA data, the figure had risen to about 5 million. The rise of amphetamine over the following two decades may be clearest if we look at a different metric: between the years 2000 and 2022, the sheer weight of amphetamines distributed to pharmacies grew tenfold, from 3.6 metric tons to 36 metric tons. Today, Americans take more than twice as much amphetamine as Ritalin. The majority of patients are still children, but, following the conclusion in the 1990s that ADHD can persist into adulthood, a rising fraction of young adults take amphetamine too.
There are individuals who see so much improved function from taking amphetamine that prescription is appropriate. But it is hard to deny that relaxing restrictions has led to misuse. A recent study noted that rates of stimulant prescriptions in the United States grew by 250 percent from 2006 to 2016, while the rate of ADHD diagnosis only slightly increased. A 2015 analysis estimated that seventeen percent of college students were misusing stimulants, both for fun and to study harder. And on the 2021 National Survey on Drug Use and Health, respondents representing 3.7 million Americans admitted to misusing prescription stimulants in the past year.
At sufficient doses, such misuse can lead to the known harms of amphetamine abuse: psychosis, seizure, and heart attack, to name a few... (MORE - missing details)
EXCERPTS: Americans can’t find enough Adderall. In 2021 pharmacists filled over forty million prescriptions for the popular ADHD drug, a sixteen percent increase in just two years. But this explosion in demand, likely driven by lax telehealth prescriptions during the pandemic, has run up against available supply. Because Adderall is a controlled substance, its production is carefully limited by the Drug Enforcement Agency. Some patients now ration their pills or drive hours to fill their prescriptions. People who have taken Adderall daily since they were children find themselves struggling to operate without it.
Americans find it only too easy, by contrast, to obtain methamphetamine. Of the 109,000 American drug overdose deaths last year, a third were caused by psychostimulants, mainly meth. That’s a more than tenfold increase in a decade, making methamphetamine second only to synthetic opioids, principally fentanyl, in driving the overdose crisis. This is in part thanks to meth’s new abundance and cheapness — by one estimate, illicit wholesale prices have fallen nearly eighty percent since 2016.
In many ways, the shortage of Adderall and the bounty of meth are unrelated problems. They affect different people, in different places, and at different scales. But the drugs are also chemically similar....
[...] The return of meth in the mid-1990s could, of course, just be attributed to declining taste for cocaine, or to an accident of efficiency. What makes it interesting, culturally speaking, is that it was more or less simultaneous with the return of pharmaceutical amphetamine — and with the explosion in ADHD diagnoses.
Children have been diagnosed with the symptoms we now identify as ADHD for over a century. The 1968 second edition of the Diagnostic Standard Manual of Mental Disorders included “hyperkinetic impulse disorder.” In the third edition it was renamed “attention deficit disorder,” or ADD, with and without hyperactivity. Amphetamine was used for treating patients, although the frontline treatment was methylphenidate, better known as Ritalin. But medicating kids was both controversial and relatively rare. The early 1970s saw a massive dispute over the prescription of stimulants to children, despite the relatively small number of children receiving them, perhaps two hundred thousand.
Then, in the 1990s — by which time ADD had become lumped together with ADHD as a single disorder — diagnoses began to boom. In 1997, when the CDC first surveyed the prevalence, six percent of American children were diagnosed with ADHD. Today, the figure is ten percent. The reason for the change is not perfectly clear. It may have been increased public awareness and testing, or shifts in diagnostic criteria, or both. What almost certainly fueled the trend was when, in 1991, the federal government said that students with ADHD diagnoses could receive special education services.
For our purposes, though, the most noteworthy change is the 1996 approval of Adderall, an amphetamine preparation, for treating ADHD. That year, there were 1.3 million amphetamine prescriptions, mainly Adderall. Just three years later, according to DEA data, the figure had risen to about 5 million. The rise of amphetamine over the following two decades may be clearest if we look at a different metric: between the years 2000 and 2022, the sheer weight of amphetamines distributed to pharmacies grew tenfold, from 3.6 metric tons to 36 metric tons. Today, Americans take more than twice as much amphetamine as Ritalin. The majority of patients are still children, but, following the conclusion in the 1990s that ADHD can persist into adulthood, a rising fraction of young adults take amphetamine too.
There are individuals who see so much improved function from taking amphetamine that prescription is appropriate. But it is hard to deny that relaxing restrictions has led to misuse. A recent study noted that rates of stimulant prescriptions in the United States grew by 250 percent from 2006 to 2016, while the rate of ADHD diagnosis only slightly increased. A 2015 analysis estimated that seventeen percent of college students were misusing stimulants, both for fun and to study harder. And on the 2021 National Survey on Drug Use and Health, respondents representing 3.7 million Americans admitted to misusing prescription stimulants in the past year.
At sufficient doses, such misuse can lead to the known harms of amphetamine abuse: psychosis, seizure, and heart attack, to name a few... (MORE - missing details)
