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Guys-Can A Dr. Of Osteopathic Medicine Rx Adderall?


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#21 Ferret

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Posted 14 November 2013 - 01:46 PM

God help us all from some Doctor's concept of Intervention and their concept of what is "good" for the patient. They even ignore DNR wishes if it serves their purposes. Wishes that were written by patients and signed and witnessed when they were of sound mind and body. However, I am now off topic.



#22 purpley

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Posted 14 November 2013 - 01:50 PM

For insurance companies, everything related to stimulant prescribing is about money. For doctors, money isn't the issue -- it's medical ethics in caring for patients, and liability.

If you [this is the generic "you," not anyone in particular] go to a doctor and tell them that only 300mg a day of Prozac works for you when the maximum recommended dose is 80mg, they won't mind writing a prescription because the minimum lethal dose is well over 1000mg in most cases and there's no street value to it. Plus there aren't any studies showing that people who take 300mg a day of Prozac can end up with even more depression and need escalating doses of the med to get the same effect. So they might have you sign a form to show you've been told of the remote chance of an arrhythmia, but that's it.

There's no absolute toxic dose for Adderall because people develop tolerance over time. But there's no way for a doctor to tell the difference between someone who's tolerant and someone who's not, or even between someone who takes the full prescription or not. A drug test only proves you've taken some, but not how much. Just 300mg can cause a heart attack or stroke in someone who's drug naive -- 450mg without question. And even a history of filled prescriptions doesn't prove tolerance because there are people who fill prescriptions and then sell them. So you're in the really lousy position of going to a doctor and asking for a potentially lethal dose, of a drug with high street value, and of a drug that's known to potentially cause increasing problems with sleep and wakefulness the more you use of it. Many doctors wouldn't write that prescription. Not because they're ignorant, but because they just can't know the truth of the matter and they're going to err on the side of not killing you or making your narcolepsy worse, not losing their license, and not potentially contributing to the US drug trade. And many of them are the really good docs, the ones who would rather lose your business than write that prescription.

So that's the problem. And we can rail against it, but there isn't any easy answer.

#23 Hank

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Posted 14 November 2013 - 03:33 PM

If you have built up a tremendously high tolerance to Adderall overtime, so that you require 300+mg/day, that is the reason for the high dose.

 

It is not as though you have such extreme Narcolepsy/Hypersomnia that only that dose will control your EDS. You have developed and extremely high tolerance.

 

As time goes on, your dependence will continue to increase.

 

So, Adderall is not your only stimulant option. I am no expert on stimulants and I do not tolerate them well. Switching over to a Ritalin, concerta or Focalin could allow you to move onto a reasonable dose of a different stimulant while re-setting your tolerance to Adderall.

 

My opinion is that you are strongly committed to a losing cause because you will eventually run out of doctors willing to prescribe. You are painting yourself into a corner.

 

You have built up an enormous tolerance. You are looking for a doctor to accommodate your tolerance and accept all the risks that go along with that.

 

My opinion is that you need a doctor to find a way to address your tolerance and prescribe a different stimulant to treat your EDS.

 

So, your EDS is not as severe as your tolerance. In my opinion your posts actually speak to the severity of your tolerance, not the severity of your EDS. It is also apparent that you are not fully aware of that.

 

It reminds me of a news show about a 900 pound man and how much he "needed to eat". Yes- he needed all that food to maintain his 900 pound weight. He and his wife considered all that food to be what he "needed". What that man needed was a doctor to propose a diet plan to decrease his weight. He did not need a doctor to prescribe more food to maintain his obesity.

 

So, to me, your extreme tolerance seems like the huge food intake of a 900 lb man.



#24 Ferret

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Posted 14 November 2013 - 10:10 PM

Interesting point of view Hank and I hope that Doin' will consider all other options if at all possible.

 

And then there's the person who consumes so many calories during the course of the day that they should weigh far more than they do...but they're skinny as a rail. And then there's the majority of Narcoleptics who hardly eat anything but can't get rid of the weight even with dieting and exercise. I fell into the last category until I started taking 100 mg. of Provigil a day...30 pounds gone in 4 months with no other changes.

There are many things that are unexplainable.

 

I wish you the best Doin'....even if you're an unexplainable anomaly.



#25 ironhands

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Posted 14 November 2013 - 10:11 PM

i'll take some of what you're having please.



#26 Ferret

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Posted 14 November 2013 - 10:32 PM

i'll take some of what you're having please.

 

Ask your Doctor...but be aware that that is how it works for me. It may not have the same effect on you AND you may experience side effects which I have not. Another mystery...even the people who make this drug don't understand how it works.



#27 ironhands

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Posted 14 November 2013 - 10:39 PM

yeah, modafinil appears to work directly on the orexin "system" from what people suggest... since orexin itself is only a recent discovery, it's no wonder people are still getting used to it.  That's one reason I want it, compared to amphetamine, it seems to work more directly with the systems that are making me sleepy (and hungry!) than just dealing with the fatigue/EDS



#28 doinmdirndest

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Posted 15 November 2013 - 01:23 AM

d. right. I know what I need. thanks, ferret. the waivier idea is a good one. i am not optimistic about any such rules change. the medical establishment and governing beurocracies have so g. d. much.....inertia. who can get through to them?

#29 doinmdirndest

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Posted 15 November 2013 - 01:30 AM

If you have built up a tremendously high tolerance to Adderall overtime, so that you require 300+mg/day, that is the reason for the high dose.
 
It is not as though you have such extreme Narcolepsy/Hypersomnia that only that dose will control your EDS. You have developed and extremely high tolerance.
 
As time goes on, your dependence will continue to increase.
 
So, Adderall is not your only stimulant option. I am no expert on stimulants and I do not tolerate them well. Switching over to a Ritalin, concerta or Focalin could allow you to move onto a reasonable dose of a different stimulant while re-setting your tolerance to Adderall.
 
My opinion is that you are strongly committed to a losing cause because you will eventually run out of doctors willing to prescribe. You are painting yourself into a corner.
 
You have built up an enormous tolerance. You are looking for a doctor to accommodate your tolerance and accept all the risks that go along with that.
 
My opinion is that you need a doctor to find a way to address your tolerance and prescribe a different stimulant to treat your EDS.
 
So, your EDS is not as severe as your tolerance. In my opinion your posts actually speak to the severity of your tolerance, not the severity of your EDS. It is also apparent that you are not fully aware of that.
 
It reminds me of a news show about a 900 pound man and how much he "needed to eat". Yes- he needed all that food to maintain his 900 pound weight. He and his wife considered all that food to be what he "needed". What that man needed was a doctor to propose a diet plan to decrease his weight. He did not need a doctor to prescribe more food to maintain his obesity.
 
So, to me, your extreme tolerance seems like the huge food intake of a 900 lb man.

good angle but it's almost no good. my tolerance is high for all stimulants. had to take up to 1.5g of nuvigil to get a days work. rotating methlyn and Adderall had a marginal effect in staving off tachyphylaxis.

#30 doinmdirndest

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Posted 15 November 2013 - 01:53 AM

For insurance companies, everything related to stimulant prescribing is about money. For doctors, money isn't the issue -- it's medical ethics in caring for patients, and liability.

If you [this is the generic "you," not anyone in particular] go to a doctor and tell them that only 300mg a day of Prozac works for you when the maximum recommended dose is 80mg, they won't mind writing a prescription because the minimum lethal dose is well over 1000mg in most cases and there's no street value to it. Plus there aren't any studies showing that people who take 300mg a day of Prozac can end up with even more depression and need escalating doses of the med to get the same effect. So they might have you sign a form to show you've been told of the remote chance of an arrhythmia, but that's it.

There's no absolute toxic dose for Adderall because people develop tolerance over time. But there's no way for a doctor to tell the difference between someone who's tolerant and someone who's not, or even between someone who takes the full prescription or not. A drug test only proves you've taken some, but not how much. Just 300mg can cause a heart attack or stroke in someone who's drug naive -- 450mg without question. And even a history of filled prescriptions doesn't prove tolerance because there are people who fill prescriptions and then sell them. So you're in the really lousy position of going to a doctor and asking for a potentially lethal dose, of a drug with high street value, and of a drug that's known to potentially cause increasing problems with sleep and wakefulness the more you use of it. Many doctors wouldn't write that prescription. Not because they're ignorant, but because they just can't know the truth of the matter and they're going to err on the side of not killing you or making your narcolepsy worse, not losing their license, and not potentially contributing to the US drug trade. And many of them are the really good docs, the ones who would rather lose your business than write that prescription.

So that's the problem. And we can rail against it, but there isn't any easy answer.

boy do i keep the Adderall rx top secret! especially if/when i chance to encounter old cronies. last thing i need is for my pharmacist to get robbed because the wrong people learned he's got to order a huge amt. f amphetamines each month. i take each and every pill myself, believe me. redistribution risk is a concern no doc has brought up. testing for how much med is in my system would certainly address it. boom. done.

#31 doinmdirndest

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Posted 15 November 2013 - 01:58 AM

i'll be darned, something i posted drew a big crowd/lots of replies. thanks for the huge response and all your input, all. this must be my 15 minutes of fame.

#32 purpley

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Posted 15 November 2013 - 10:21 AM

boy do i keep the Adderall rx top secret! especially if/when i chance to encounter old cronies. last thing i need is for my pharmacist to get robbed because the wrong people learned he's got to order a huge amt. f amphetamines each month. i take each and every pill myself, believe me. redistribution risk is a concern no doc has brought up. testing for how much med is in my system would certainly address it. boom. done.

 

Yeah, no doctor will tell you that redistribution risk is a concern (ER docs being a notable exception) because there's no point in bringing it up.  Either the person isn't diverting it and will be offended, or the person is diverting the medications, and why piss them off?

 

Unfortunately, there's no commercially available test for an amphetamine level, and even it there were, there would be no way to correlate it to the dosage you take -- people's metabolisms are too variable.  So the drug tests are just "yes/no."

 

All I can say is, please consider ALL your options.  You've been on high-dose stimulants for years (decades, right?) and there's no way to figure out now whether what you experience when you lower the amount is primarily amphetamine withdrawal or the narcolepsy.  You might find that if you reduce your physiological dependence on the stimulants, you won't need the amount for the narcolepsy which you think you do.  Even if you needed high doses of stimulants when you were younger, you probably don't need as large an amount now because we eliminate meds more slowly as we get older.  The only way to know is to get back to the basics.  And the alternative is to either keep scrambling to find doctors who will prescribe these kind of doses for you or to find alternatives to obtain the dose you're taking, all of which could end up with you in serious legal hot water.



#33 doinmdirndest

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Posted 15 November 2013 - 11:48 PM

well, a 3 month washout lowered my tolerance but a few weeks. likely i'm stuck w/finding doctors, unless I get one that writes the rx in need, or specifically, continues it, that is going to be accessible to me for the balance of my life.

as i'm 52, any young doctor that will take it on will do.

there is a third alternative: manage to change the course of sleep medicine so as to have extremely rare cases like mine accommodated in the prescribing of stimulants. I have been searching for other such cases.

I am not sure where to go from there, but i'm certain this is important. 3 years of exsaustive online n. forum 'fine tooth comb' approach has turned up 3 anonymized individuals. they are/were not here in nn. one is stimulatednarcoleptic from www.sleepconnect.com who has yet to be contacted by me, and arizonahugs from www.talkaboutsleep.com, and moshe turner from linkedin's n. 'open discussion'. these 2 are complacent and are satisfied w/the status quo, or I did not convey adequately reasons why changes should be made. all 3 have/had stimulant regimens the doseage of which is/was on par w/mine.

is there anybody here w/high dose needs/indications/treatment?

#34 Hank

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Posted 16 November 2013 - 11:53 AM

there is a third alternative: manage to change the course of sleep medicine so as to have extremely rare cases like mine accommodated in the prescribing of stimulants. I have been searching for other such cases.

 

In my opinion, you do not have a "rare case" of Narcolepsy. You have a common case of drug tolerance resulting from years of increasingly high doses. Nothing rare about it.

 

The doctors who do not prescribe are the ones who actually understand what is going on for you. The ones who have prescribed have been part of the continuing problem. Or, in the case of the psychiatrist you mentioned, maintained your tolerance while attempting to prevent your "alternate methods" of increasing your tolerance.

 

It seems that the only long term solution is to address your tolerance issue. You have made a long series of short term decision which have led you to this situation. I am not blaming you for this- we have all done the best we could.

 

However, you are rapidly running out of short term options. You are going to need a change of course. You will need a long term solution.

 

Your Narcolepsy or IH is not rare. Your tolerance is common- it is common among "self medicators".



#35 doinmdirndest

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Posted 17 November 2013 - 03:47 AM

the bottom line is that my treatment works.  period.  there are no contraindications, the drug is well tolerated.  there is no decision regarding my treatment from the new doctor I haven't met.  the md that will see that i'm robust/well/functioning as an employed citizen as the product of my treatment is somewhere to be found and I

 will find that doctor.

 

n. and ih patiemts are born, not made.



#36 Ferret

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Posted 02 December 2013 - 02:56 PM

So, just out of interest, I asked at the Pharmacy today if Adderall requires a prescription in Mexico. The answer is NO.

Ritalin requires a prescription but Adderall does not...go figure.

I'm obviously NOT going to send it up to anyone. But, there ya go...Modafinil and Adderall are both available in Mexico without a prescription.

#37 ironhands

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Posted 02 December 2013 - 03:41 PM

Kinda shocked about Adderall, Modafinil I could see as it has a much much lower degree of abuse, comparatively speaking.



#38 Ferret

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Posted 02 December 2013 - 11:12 PM

I MADE A MISTAKE. I'M SO SORRY!

I asked the Pharmacist about EFFEXOR not Adderall.

I will ask about the Adderall the next time I'm in there though.



#39 doinmdirndest

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Posted 03 December 2013 - 03:12 AM

the problem now eroding American medicine began in 1914.  a legal precept, Harrison narcotics act of '14, was made law.  prior to this addiction as a concept was the problem  of the individual adult citizen ALONE, if indeed a problem exists.

 

this was not how the founding fathers intended our society to be governed.  it has it's impact on medicine.  pwn and anyone indications for a scedule 2 rx pays one aspect of the price this precept* exacts upon individual liberty.

 

adults should not be protected from themselves.  this fails.   you can't legislate responsibility.