Five sentence summary ADHD medications, which are almost always stimulants, are Schedule II substances in the US, making them hard to obtain. The federal and state government have rules for prescribing them and doctor's offices and insurance companies may make their own rules in addition, so there is considerable variation in how difficult it is for someone to get their prescription. It's not easy though, despite the fact that stimulants lower the likelihood ADHD folks will engage in dangerous and risky behavior, including abusing drugs. Stimulants are most likely to be prescribed Let's get a few things clear on ADHD medications. They are one of the most effective treatments for ADHD symptoms. A 2023 review found "no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms." When we're discussing ADHD medications, the vast majority of the time, we're referring to stimulants. You may have heard of methylphenidate, dextroamphetamine, amphetamine, lisdexamfetamine, Concerta, Adderall, or Ritalin; they're all stimulants. There are medications that are not stimulants, one of the most popular non-stimulants is Straterra (brand name for atomoxetine), but they are generally not as effective and take longer to have an effect (see studies here and here ). Laws and rules in the US In the US, stimulant ADHD meds are classified as Schedule II substances by the Drug Enforcement Administration (DEA). The federal government believes these drugs have "a high potential for abuse which may lead to severe psychological or physical dependence." Getting ADHD medications is not easy or straightforward, and I mean getting them with a prescription and after thorough ADHD testing and diagnosis. For folks who have trouble with executive functions, we need to use a lot of them in order to actually get our mediciations. Because they are schedule II drugs, this means we cannot get refills. This is a federal law. A new prescription must be written up every. single. time. We cannot put these medications on auto refill at the pharmacy. Instead, we have to call up our doctors every time we need more. This also means prescription can't be transferred from one pharmacy to another. Ever. So if a pharmacy is out of Ritalin, we have to call our doctor and get a new prescription written for a new pharmacy. There are federal laws covering ADHD medications and there are also state laws covering ADHD medications. What is required in Montana may not be required for someone in North Carolina. It used to be that schedule II presriptions had to be written out on paper, but now they're also prescribed electronically (they cannot be prescribed verbally). In some states, the law may require doctors to see you every three months whereas in a different state the law requires visits every six months. Varies by state:
Insurance companies you and doctor's office may impose their own standards and norms. One medical office may refuse to 90-day mail order prescriptions, even if legally permitted by the state, as a policy to reduce potential abuse. Some college and university health clinics will not see students for ADHD diagnosis or allow their doctors to write prescriptions because they're worried about abuse. An insurance company can decide all doctor's appointments for ADHD refills need to be done in-person and not by telehealth. I had an insurance company initially refuse to cover ADHD medications because I was over 21 and they thought ADHD meds were only used by those still in school. My doctor had to appeal and write an explanation of how my ADHD affected my life and why I needed medication. Thankfully, the insurance company agreed to cover the meds. The hoops ADHD folks have to jump through can come from federal regulations, state laws, doctor's offices, and insurance companies. Addiction risk Class II substances pose a greater risk for addiction and abuse. Here's the catch: for folks with ADHD, taking stimulants lowers our chances of drug addiction (see here and here). This shouldn't be surprising if you take ADHD seriously. When we take our medicines regularly, the likelihood of risky and dangerous behavior, including abusing stimulants, decreases (see here and here). Abuse by folks without ADHDI'm not going to tell you folks don't try and fake an ADHD diagnosis. Many students know an ADHD diagnosis can mean 1.5 time on tests or access to Ritalin. That said, it's hard to know just how many students are taking medications without a diagnosis of ADHD. It doesn't look like huge amounts of ADHD meds are circulating through US schools though (see here). In an expected twist, college students who misuse ADHD meds very well might have ADHD. That's not to say that every individual abusing ADHD meds has undiagnosed ADHD, but it makes sense that some do. Whether or not ADHD is overdiagnosed is another hard question to answer because how ADHD is diagnosed isn't standardized, many studies are done primarily on white male children, and ADHD symptoms are diverse and overlap with other conditions. As to overdiagnosis, the evidence is mixed: ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?, Evaluating the Evidence For and Against the Overdiagnosis of ADHD, Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents A Systematic Scoping Review. This does NOT mean ADHD isn't real or that those with a diagnosis are lying. Key points:
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AuthorThere's a reason theADHDAcademic is an anonymous account and there's a reason why this website will remain anonymous That said, there are some basics it might be helpful to know about me: DISCLAIMER: I am not a medical professional or a lawyer of any kind. All text, graphics, and content on this website are for educational purposes only. Any and all content should not be substituted for medical or legal advice. Although I strive to provide the most accurate, current, and scientifically sound information, content should never be substituted for professional advice. Always consult a medical and/or legal professional before making any decisions. Links are provided only for reference and do not necessarily imply endorsement.
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