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PaperclipPerfector  4mo ago (text post)   4744 thread views

Small-Scale Question Sunday for December 24, 2023

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

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So what's up with the amphetamine shortage? I can't tell if this is a shortage shortage, or if you just have to call up your psychiatrist in a panicked tone and mention the fact that you are literally out and won't be able to work tomorrow, and then they'll point you towards the secret stash.

Asking for a friend obviously.

Tagging on to your top level post to ask a question of the other users. Several have mentioned that AMPH is a ‘better’ class of stimulant than MPH. Why do people feel this way? Subjectively, it seems like amph is ‘speedier’, which means more enjoyable but also more prone to distraction, and with a bigger lag/crash after it wears off. Mph, in contrast, feels like less of a boost and more of a removal of fatigue, with less of a crash (but potentially a headache later).

Obviously responses are individual. What is the rest of the Motte’s experience?

Basically this is a long standing issue stemming from restrictions on production that pops up periodically. Not a new problem but it affects different people at different times depending on where the meds end up getting distributed.

One example: https://old.reddit.com/r/medicine/comments/16dur21/stimulant_shortage_im_giving_up_yall/?rdt=65353

"Listened to a great podcast recently with an ADHD expert, who noted that in a recent meeting with the DEA and FDA all the reps of manufacturers said they were having no problems with demand and production, as has been noted in several comments. The distributors were the problem. The wholesale distributors got hit hard in the Perdue Pharma settlements. For things like supplying 450,000 opioid tablets to a single pharmacy in West Virginia, in one year, et cetera. So they just decided, extralegally, that they were going to limit distribution of ANY Schedule II drugs to pharmacies. Pharmacies cannot supply what they cannot get because of the distributors decisions."

This seems like the missing piece of the puzzle to me. The shortage has been going on for over a year at this point. If FDA/DEA quotas were the issue then the FDA/DEA could simply raise the quotas. But if manufacturers and distributors are afraid to ship out drugs in a way that might look suspicious because they're afraid of being sued, that is a much harder problem to solve.

Reminds me of the Covid vaccine rollout hiccups, but slightly less stupid because bad things can in fact happen if crates full of amphetamine end up distributed but unaccounted for.

One of my coworkers who is a programmer/SE mentioned to me he couldn't get any and it was affecting his job performance and we are a SV company with excellent health care coverage so it has to be real. This is in the Denver area. Like he is a top level SWE so if he can't get it nobody can.

Do you live in a college town?

And here I am swimming in them. Shame it's so hard to get the better class of stimulants, I'm not fond of Ritalin.

Any idea why this is the case? I don't know what the situation is in India, but I have read about other countries prohibiting medical amphetamines and allowing medical phenidates. I've never seen an explanation for the distinction though. Is it just fear of the second order effects of introducing a legal path to acquiring the, ahh, better stimulants?

They're legally (and for the most part medically) considered equivalents in the US. Though as you note and in my own experience, one is a lot better than the other in terms of side effects etc.

I would wager it's largely the stigma around amphetamines in general. I don't know any good reason why you'd ban those and allow phenidates, though I know Japan takes the opposite route and bans both, RIP ADHD-ists.

I don't think it's so much a fear of allowing legal amphetamines as much as an aversion to the entire class in general. And there's not much impetus to change things, at least in India, awareness of ADHD is minimal, and "a" drug exists, so it's not like it goes entirely untreated. MPH is ok, in effectiveness if not in terms of how pleasant it is to use.

(In terms of pure availability, India manufactures a ton of the stuff, including what you might import in the States, so it's little surprise we don't have a shortage)

So the status quo allows ADHD to be treated without introducing the wildcard of amphetamines. This makes sense. From what my Indian friends and acquaintances tell me, mental/psychiatric health awareness in general is minimal there so I'm not surprised there is no urgency to make changes to a system that provides at least some avenue for treatment.

I know multiple people that purchase all of their pharmaceuticals, from OTCs to scheduled drugs like modafinil, from online Indian pharmacies (mostly as a work-around for various insane US pharma and insurance pricing) so that also makes sense. Thanks.

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