banjiwayume

Anyone on dexedrine

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Has anyone noticed that dexedrine is getting harder and harder to get and if you have are you going to switch meds?????

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No, the Walgreens I use seems to always have it in stock. I take the IR + Vyvanse. Are you taking the Dexadrine Spansules or the 10 mg dextroamphetamine IR tablets ? Seems only 3 manufactures are approved to make the IR or Spansule.

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Yeah, I might have to wait a couple of days, but it's no big deal.

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I take 80 mg a day of the ir so 240 a month and the last few moths ive had problems with barely getting it or there not being enough and they cant even order it.

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baniwayume,

Yes, I am angry that Glaxo Smith Kline, dis-continued Dexedrine 5 mg peach/orange colored 5 mg triangular hearts were discontinued, during

2009. I have been on stimulants since 1994 contiinuously////before my 1994 to 1998 Psychiatist, moved out of state, and closed his practice, I

had 4 scripts, he wrote me, in December of 1998, each for 150 5 mg Dexedrine instant release E-19 triangular hearts, each, postdated, every 90 days, until Dec of 1999. thus, I had 150 tabs times 4 = 600 tablets of Dexedrine, I have about sixty (60) left of that good bye Xmas gift in 1998, I never would have

dreamed (in my lifetime) that Smith Kline and French, of Philadelphia, PA who had nearly 50% of the amphetamine market, in the late 1960's, would,

actually, abandon the entire stimulant market. First, they dropped the 5mg Dexedrine sulfate tabs, (2009) with short notice, then, I discovered, after paying

out of pocket, as my insurance carrier back as far as the year 2000, would not pay a dime on "brand" Dexedrine Spanules 15 mg. speckled pink & white with

the brown caps, started farming out their Dexedrine Spansules with the merger in 2002/2003 with the United Kingdom conglomerate, Glaxo, to form,

transition no 2, from the mid 1980's merger, with Smith Kline Beecham, to "Glaxo Smith Kline" this time moving from Philadelphia, Pa, to Research

Triangle Park, Raleigh-Durham, NC, with world hdqtrs in the United Kingdom, and, by "farming out their amphetamines production" I mean, I discovered on the 11th hour, that, they, GSK, licensed, some small unknown, pharmaceutical manufacturers, to produce, first, the Dexedrine 5,10, 15 mg patented Spansules, to,

Catalent Pharma Solutions, in Albuquerque, New Mexico, and to another location of Catalent Pharma Solutions, in Kentucky,...in addition to that....

they licensed out the giant Abbott Labs, once famous for holding the patent on "Desoxyn gradumet 10 and 15 mg Methamphetamine tablets, and, in my

humble opinion, the very best, absolutely smoothest "speed" in the whole wide world, from the 1960's until July 1, of 1973, when "big brother, our Drug

Enforcement Administratrion" banned the sale in the USA of all forms of "combination amphetamine tablets and capsules combined with sedative and strong

hypnotiics.....I was very fortunate, to have one last year summer of 1972 until summer of 1973 of Abbott labs, patented "Desbutal" which came in 5 mg capsules, 10mg. multicolored tablets, and the ultimate, 15 mg multicolored tablets, with all forms of Desbutal, to have Abbott Labs, "Nembutal" on the street known as "yellow jackets" with pure Methamphetamine. The strongest version, I had continuous scripts for, was the 15 mg "Desbutal Gradumet tablets, containing 15 mg of methamphetamine, (Abbott Labs patented infamous DESOXYN WITH 97 MILLIGRAMS OF NEMBUTAL. The Nembutal was instant release, the fastest acting barbituate, available, (along with Eli Lilly's Seconal (red devils) that hit your brain first, then, the strongest speed known to man, METHAMPHETAMINE, was released in a time delayed mechanism, that, truly, was a dream come true euphoric drug experience....a very, very relaxed warm fuzzy feeling first,, then, a wide awake, hit the ground running, methamphetamine sustained release, would take over within one hour, and one was off and running "focused" for a beginner like me, for a good 10 to 12 hour run!!! To be very realistic, the Abbott Labs cousin, pure Desoxyn, in 5mg tablets, were just too strong for me, even in my robust age of being in my early 20's, as it was so strong, it was the only stimulant, that would make my teeth grind, and my

pupils dilated, just like, the once very popular, 25mg instant release "Preludin" and the 75 mg, sustained release "Preludin" tablets, banned in the 1970's worldwide, as being too addictive, as it was marketed as a "diet pill". (Phenmetrazine HCI) those 25mg I/R pills were twice as strong as Dextroamphetamine sulfate, the perfect drug of choice since I started using stimulants in 1969. I am 62 yrs old now, and, have a steady supply of the cheaper Barr Labs

generic version of GSK's Dexedrine Spansules, because I don't know of any major insurance company that will pay for GSK's continued price increases on that med, I was paying about $92.00 for 60 of the 15 mg GSK brand Dexedrine Spansules, and by 2008, the price increased to $138.00 cash in fist, for me to pay out of pocket, thus, I switched for economic reasons, to Barr Labs generic Dexedrine capsules, "not the famous tapered end Spansules" for a co-pay of only $10.00 per month, and, another co-pay of generic Barr Labs version of brand Adderall 12.5 mg x 90 pink tablets per month, for a co-pay of ten bucks.

Just to not to be seen as a braggart, I pay for private insurance, since I am self employed, and I pay $515.00 per month, that is a BMW payment, for just a skimpy 70/30 major medical insurance, and, Dental insurance, with a $3,500 minimum deductable on major medical, a $200.00 deductable on my first of the new calender yr of prescription, mostly generic only meds, and for Dental Insurance, I have a ceiling of $1,000.00 in a calender yr for any dental work, in addition to that, I have "no mental health coverage for inpatient mental health, or outpatient mental health office visits" thus, IMHO, I pay dearly for my

:"cheap on the surface co-pay for mostly generic versions, of often, truly inferior ethical pharmaceuticals. I also take Roche Klonopin, to wind down at night, and my insurance firm, Blue Cross, Blue Shield, will not pay one cent on brand Roche Klonopin, which is almost $3.00 a tablet, so, I get the generic version by Actavis, which is $10.00 co-pay for 30 tabs of 1mg per month, I tried Roche Valium, in 2009, from my Dentist, and, it costs me $4.93 cents each out of pocket for the fancy V-Cut artwork on the blue 10mg, Mona Lisa priced Roche Valium. where as, the wholesale price for Qualitest, or Mylan, Diazepam 10 mg is only 35cent each, or about $35.00 per bottle average wholesale costs. I used to get Roche Valium, retail for one dollar each, at national chains, in the USA cash out of pocket for about $120.00, as the markup with pharmacies in 1994 was 20% of wholesale price, the 2009 price of 100 Roche Valium is now, $493.00 average wholesale price, for Roche Valium, which is almost, 38 1/2 yrs old, introduced in 1963 originally. I can remember in the early 1970's of paying 35 cents apiece for brand Roche Valium, when it was still under patent protection. Crazy world isn't it? To answer your question, my independent pharmacist, in a city of over 500,000 people does not even stock Roche Valium or GSK Dexedrine Spansules 10mg or 15 mg, or even Roche Klonopin, because no one can afford these pills, unless you have"money to burn". My pharmacists, can get it in a 24 hour notice, from some drug wholesalers warehouse in my city if I really want them. I think that is part of the reason you notice a shortage, also, C-II drugs are and have always been on a quota, with the DEA, and when the quota is close to the calender year limit, the manufacturers of all C-II meds, cut back on production, due to pressure from the DEA,

I know for a fact some Canadian friends of mine, faced critical shortages, when Glaxo Smith Kline also licensed out all production to I think Marathon Pharmaceuticals or some small firm in Canada during 2009 and early 2010, and Dexedrine in all forms was on backorder in Canada. Also, GSK, has also stopped manufacturing their own Dexedrine for their internatational headquarters in the UK, and, have licensed for a number of yrs now, for a another pharmaceutical firm, located in Ireland, to export, Dexedine, to citizens of England. Source: Martindale, the Complete Drug Reference, 3,600 pages of ethical pharmaceuticals in forty countries of the modern industrialized world, it is published by Pharmaceutical Press of London, UK and sells for $600.00 US and is published every other year, I buy a used set on some used booksellers websites, and pay like $400.00 including shipping for the 2009 version, or, even less, for a ten year old version, going rate about $125.00, for a 2003 book, vs. the USA PDR retails for about $70.00 if you pre-order in advance, or less if you hunt the books on E-Bay, the older the cheaper, unless it is a antique book Grade A that is maybe 40 or 50 yrs old. As far as I know, "Dexedrine 5 mg the so caled pink or orange hearts had a production run of 62 yrs, setting a world record in the USA being introduced in 1937, along with the now discontinued Smith Kline and French Bennies (Benzedrine) Frank Borman, and all of the astronaults had Dexedrine, in their medical kits during the Mercury circle the earth missions, as well, as the journey to the moon, in 1969, and Dexedrine was used by many of our WWII piilots on the B-29 bomber missions, and especially the B-52 bombing missions on long haul dangerous flights by the pilots and flight engineers, during the Vietnam War, as well as Benzedrine.

1968 PDR lists 24 different versions of amphetamine products, and many, many manufacturers...

2011 PDr lists only about 5 or 5 manufacturers and products of stimulants, primarily versions of methylphenidate, one firm marketing Methamphetamine, and

the few others, Barr Labs, ShireUS, Core/Ranbaxy, making up most of the rest of the product line. A sad demise, as the fasr acting amphetamines are

almost extinct, with the ultra expensive Desoxyn 5 mg methamphatamine, the only one left that is pure instant release, unless, Barr labs has a generic substitute for the now discontinued Dexedrine sulfate, and the discontinued, Dextrostat tabs, Ethex was shut down by the DEA for allegedly making too powerful a version of the dextroamphetamine sulfate. and Ovation Pharmaceuticals, charges wholesale $381.65 for 100 tablets of five mg methamphetamine, and good luck locating a Psychiatrist, on writing a script on that medication, I haven't seen any Desoxyn since the year 1973, and many shrinks are fearful of writing a script for meth, because of the stigma associated with it, even my M.D of 12 yrs, a Attention Deficit Disorder specialist, and a certified Addictionologist from the University of Florida, Gainesville, who is in his late 60's will not write a script for either Desoxyn, or the former 5 mg Dexedrine sulfate, due to pressures from the DEA placed upon him, as many traditional college students with bona fide A.D.D 314 diagnosis, he still will not write a script for those two meds due to the liability placed upon him. Not even me, with a track record of using 3 psychiatrists since 1994, without any signs of abuse, he still wiill not do it for me. Since ADD was not recognized in adults until around 1990, the scripts I obtained especially in the 1970's were from what are referred to (i hate this label) were from script writers, who wrote Quaaludes and Dexedrine and/or Desbutal for me, just told me to fill the "Ludes" at a different pharmacy, and the speed, at another pharmacy, this was before the Prescription Monitoring Program, of course, and many M.D's of the early 1970's were still conditioned to writing pills for weight control, or in college towns, for cramming for exams. Not true in anymore. long gone...................over 25 to 30 yrs ago.

Lance Larson

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Still in 2017 I am finding it hard to get my Dexedrine Spansules. I usually have to go to at least 3-4 different pharmacies before one of them says they have it in stock or can order it within a reasonably time. I find Giant Pharmacy, however, to be much better than other pharmacies in terms of having it in stock and quickly ordering it for me. 

On 11/28/2011 at 5:22 AM, LanceLarson said:

Since ADD was not recognized in adults until around 1990, the scripts I obtained especially in the 1970's were from what are referred to (i hate this label) were from script writers, who wrote Quaaludes and Dexedrine and/or Desbutal for me, just told me to fill the "Ludes" at a different pharmacy, and the speed, at another pharmacy, this was before the Prescription Monitoring Program, of course, and many M.D & amps of the early 1970s were still conditioned to writing pills for weight control, or in college towns, for cramming for exams. Not true in anymore. long gone...................over 25 to 30 yrs ago.

Lance Larson

I wouldn't say it is long gone. There are plenty of shrinks today who prescribe stimulants for weight control. Perfect example is Vyvanse which is FDa approved for binge eating disorder. My previous psychiatrist was in my college town and always asked how my concentration was, my grades, and simply increase my dose when I would tell him I had a lot of projects or assignments coming up this week. My current doctor increases my dose of Dexedrine during the end of the semester if I even slightly mention cramming for exams. So it definitely still happens today, whether it is to a greater or lesser extent I don't know

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CVS never stocked Dexedrine for me and the pharmacy techs had trouble even identifying what the generic for Dexedrine Spansules were (I overheard them saying "I think this is just Adderall XR..." but they finally figured it out, but now they think it's methamphetamine, which is Desoxyn). When I was taking Desoxyn, after a few months of taking it, they started actually stocking it, but I took Dexedrine much longer than I took Desoxyn and they never ever started stocking Dexedrine.

I once tried to fill a Dex Spansules script at Walmart and they literally said in front of everybody "we don't carry his medicine, we haven't carried for at least 5 years, we won't order it, and we're going to have to ask you to leave." It was extraordinarily embarrassing and I felt like they were criminalizing me...

I finally found a family-owned pharmacy here in town that not only will order it, but they typically stock it, and it's even the generic brand that I like (Mallinckrodt). The frustrating thing about that pharmacy is that they refused to order Zenzedi for me, something about my insurance wouldn't reimburse them the total amount or something... It was total BS. So I had to go with generic Dexedrine, which luckily was also from Mallinckrodt when they said they normally get it from Barr (eww!).

But at least from my experience, the Mom & Pop pharmacies are more likely to have it and more obscure meds than the big chain pharmacies.

We don't have a Walgreens here in town (live in a small town), but I have heard they are good about carrying Dexedrine.

My pdoc won't go above 30 mg of Dexedrine Spansules or 20 mg Dexedrine IR for some reason... Yet she's prescribed me 90 mg Adderall XR (67.5 mg Dexedrine) and when I broke it down for her in a spreadsheet, she said something about the Dexedrine Spansules causing heart failure and there's been studies done and whatnot. I'm not convinced. Dextroamphetamine is dextroamphetamine, and Adderall is 50% dextroamphetamine and 50% racemic amphetamine, making it 75% dextro 25% levo, therefore acting more on the peripheral nervous system from the levo than pure dextro which acts more on the CNS than peripheral nervous system, which makes it less hard on the heart theoretically speaking.

Now my pdoc outright refuses to prescribe Dexedrine. Kinda frustrating. But I still love her. She's a wonderful person and pdoc.

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21 hours ago, mikl_pls said:

CVS never stocked Dexedrine for me and the pharmacy techs had trouble even identifying what the generic for Dexedrine Spansules were (I overheard them saying "I think this is just Adderall XR..." but they finally figured it out, but now they think it's methamphetamine, which is Desoxyn). When I was taking Desoxyn, after a few months of taking it, they started actually stocking it, but I took Dexedrine much longer than I took Desoxyn and they never ever started stocking Dexedrine.

I once tried to fill a Dex Spansules script at Walmart and they literally said in front of everybody "we don't carry his medicine, we haven't carried for at least 5 years, we won't order it, and we're going to have to ask you to leave." It was extraordinarily embarrassing and I felt like they were criminalizing me...

I finally found a family-owned pharmacy here in town that not only will order it, but they typically stock it, and it's even the generic brand that I like (Mallinckrodt). The frustrating thing about that pharmacy is that they refused to order Zenzedi for me, something about my insurance wouldn't reimburse them the total amount or something... It was total BS. So I had to go with generic Dexedrine, which luckily was also from Mallinckrodt when they said they normally get it from Barr (eww!).

But at least from my experience, the Mom & Pop pharmacies are more likely to have it and more obscure meds than the big chain pharmacies.

We don't have a Walgreens here in town (live in a small town), but I have heard they are good about carrying Dexedrine.

My pdoc won't go above 30 mg of Dexedrine Spansules or 20 mg Dexedrine IR for some reason... Yet she's prescribed me 90 mg Adderall XR (67.5 mg Dexedrine) and when I broke it down for her in a spreadsheet, she said something about the Dexedrine Spansules causing heart failure and there's been studies done and whatnot. I'm not convinced. Dextroamphetamine is dextroamphetamine, and Adderall is 50% dextroamphetamine and 50% racemic amphetamine, making it 75% dextro 25% levo, therefore acting more on the peripheral nervous system from the levo than pure dextro which acts more on the CNS than peripheral nervous system, which makes it less hard on the heart theoretically speaking.

Now my pdoc outright refuses to prescribe Dexedrine. Kinda frustrating. But I still love her. She's a wonderful person and pdoc.

They thought it was Desoxyn? Haha! AXR I can understand, that would be easy to confuse if you haven't encountered the d-amp spansules before, but Desoxyn? Then again if they were working off of the name alone maybe they just got Dexedrine and Desoxyn mixed up, but that doesn't explain mixing up Dexedrine with Adderall...

I'm surprised that they stocked the Desoxyn but not the d-amp. Maybe you encountered a (statistically improbable?) pharmacy with more than one patient on Desoxyn? Even then, from what I've heard Desoxyn is not cheap (from the pharmacy/insurer perspective), I certainly know it's not cheaper than d-amp IR, I doubt the spansules are much more than IR in the US if CA prices are any indication (which they should be for a generic), and no sane pharmacist would be more comfortable with Desoxyn in their CII rack than with d-amp in it... Hmm.

My pharmacy never started stocking my Fetzima even though I've been on the same dose for close to six months now, but then again that's costing my insurer something like $380 and they get it in 30-count bottles, so I guess the lack of counting required and high cost explain that. I don't care too much about waiting a day or two for it so whatever. They didn't have d-amp IR in stock when I was on that either and they didn't keep it in stock either, so Walgreens is by no means universally good about carrying d-amp (and I remember it taking them like a week to get it delivered too - odd, considering that the Fetzima is always delivered quickly).

Why the hell did the Walmart pharmacist ask you to leave like that? That's horribly unprofessional and unjustified.

Independent pharmacies are notoriously good about customer service and accommodating special requests, but they are more price sensitive because they cannot afford to loose as much money on RXs, generally have different contract terms than the big chains do with the major PBMs, and likely have higher acquisition costs than the big chains do even if they use the same suppliers, which can put them at a significant disadvantage in some cases. For example discount cards like GoodRX are a major issue for many independent pharmacies since that often leads to them loosing money or making next to nothing on the RX, but the big chains will usually eat that cost to attract more customers (although attitudes towards this are shifting and some chains have started locking out certain discount cards). What really sucks about discount cards for chains and independents alike is that not accepting them can sometimes violate their contracts with PBMs that have both discount cards and regular health insurers as clients - which puts the pharmacy in a very bad position where they can't refuse to accept the cards without breaching their contract, and to make matters worse, discount card companies are fully aware of this and basically resolve consumer issues with getting a discount card accepted by calling the pharmacy to "helpfully" inform them that they are in breach of the pharmacy's contract with whatever PBM the discount card uses and essentially threaten everyone into submission (if the pharmacist ignores them, corporate gets called next). It's all very nasty stuff.

Bluntly put, your pdoc is an idiot. There is nothing magical about pure d-amp or d-amp spansules that makes it worse for the heart than much higher doses of d-amp combined with a fricking PNS stimulant (levoamphetamine). If anything the d-amp is arguably better for the heart than the MAS due to it essentially being a purely CNS stimulant...

And given that we have firm evidence on there being no association between treatment with ADHD medication and several different types of major cardiac events for both children and adults, the only argument possible is that "supratherapeutic doses in general may raise the risk", which is possible (although I'd argue that if you lack risk factors and the dose isn't utterly insane there's generally enough precedent in the literature to justify using these doses even if we assume they do actually increase CV risk), but she's already prescribing a supratherepeutic dose of Adderall, so she can't use that argument at all and clearly already considers supratherapeutic doses to be an acceptable risk.

The real reasons of course are likely the combination of misremembered details about cardiovascular risks of ADHD medications, lack of familiarity with prescribing d-amp, much more familiarity with prescribing MAS, and unfortunately all too typical levels of ignorance about psychopharmacology among the people who are supposed to have effectively/essentially specialized in practicing psychopharmacology...

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1 minute ago, JustNuts said:

They thought it was Desoxyn? Haha! AXR I can understand, that would be easy to confuse if you haven't encountered the d-amp spansules before, but Desoxyn? Then again if they were working off of the name alone maybe they just got Dexedrine and Desoxyn mixed up, but that doesn't explain mixing up Dexedrine with Adderall...

Yeah, it was one particular pharm tech with whom I'm friends. She's a little on the "proud" side when it comes to her knowledge of pharmaceuticals. She was insistant that Dexedrine was methamphetamine. I was like, "no honey, check Epocrates. You've filled methamphetamine for me before, that's Desoxyn."

3 minutes ago, JustNuts said:

I'm surprised that they stocked the Desoxyn but not the d-amp. Maybe you encountered a (statistically improbable?) pharmacy with more than one patient on Desoxyn? Even then, from what I've heard Desoxyn is not cheap (from the pharmacy/insurer perspective), I certainly know it's not cheaper than d-amp IR, I doubt the spansules are much more than IR in the US if CA prices are any indication (which they should be for a generic), and no sane pharmacist would be more comfortable with Desoxyn in their CII rack than with d-amp in it... Hmm.

I was extremely surprised too! I live in a rather small town in which crystal meth is very prominent... And you're right, Desoxyn is not cheap. Dex IR and Spansules are both cheaper than Desoxyn, but Dex Spansules come close to the cost of Desoxyn depending on the dosage.

6 minutes ago, JustNuts said:

My pharmacy never started stocking my Fetzima even though I've been on the same dose for close to six months now, but then again that's costing my insurer something like $380 and they get it in 30-count bottles, so I guess the lack of counting required and high cost explain that. I don't care too much about waiting a day or two for it so whatever. They didn't have d-amp IR in stock when I was on that either and they didn't keep it in stock either, so Walgreens is by no means universally good about carrying d-amp (and I remember it taking them like a week to get it delivered too - odd, considering that the Fetzima is always delivered quickly).

I'm very tolerant about my current family-owned pharmacy when it comes to them not having enough of or not having a medicine in stock because they always overnight the med to be ready for the next business day. CVS would be like, "we'll order it when and if we feel like it, and oh btw we forgot to order it, so it'll be here next week instead of this week after you waited 5 days when we told you it'd be 3 days until it's here, so you get to wait a total of 1 and a half weeks, you're okay with that right?" I was glad my insurance stopped covering CVS and forced me to start going to another pharmacy despite being friends with almost everyone there.

8 minutes ago, JustNuts said:

Why the hell did the Walmart pharmacist ask you to leave like that? That's horribly unprofessional and unjustified.

I have no idea!!! I haven't been back since then though. Dude was a total douche bag about it too. Totally uncalled for. That was when I discovered my current pharmacy, which at the time became my fall-back pharmacy secondary to CVS.

9 minutes ago, JustNuts said:

Independent pharmacies are notoriously good about customer service and accommodating special requests, but they are more price sensitive because they cannot afford to loose as much money on RXs, generally have different contract terms than the big chains do with the major PBMs, and likely have higher acquisition costs than the big chains do even if they use the same suppliers, which can put them at a significant disadvantage in some cases. For example discount cards like GoodRX are a major issue for many independent pharmacies since that often leads to them loosing money or making next to nothing on the RX, but the big chains will usually eat that cost to attract more customers (although attitudes towards this are shifting and some chains have started locking out certain discount cards). What really sucks about discount cards for chains and independents alike is that not accepting them can sometimes violate their contracts with PBMs that have both discount cards and regular health insurers as clients - which puts the pharmacy in a very bad position where they can't refuse to accept the cards without breaching their contract, and to make matters worse, discount card companies are fully aware of this and basically resolve consumer issues with getting a discount card accepted by calling the pharmacy to "helpfully" inform them that they are in breach of the pharmacy's contract with whatever PBM the discount card uses and essentially threaten everyone into submission (if the pharmacist ignores them, corporate gets called next). It's all very nasty stuff.

2

This definitely my experience so far. One thing I haven't tried but fear still won't be possible is requesting specific generic brands... like Sandoz oxazepam works better for me than Activis oxazepam, and I've just been putting up with Activis from both CVS and Jones. CVS made an attempt to order Sandoz, but their supplier sent Activis anyway with a big middle finger. Same as when I tried to get Teva lamotrigine (instead of Cadista garbage that they get), their supplier sent the regular Cadista 3 times in a row, the last two times the had it overnighted, and the third time they were like, "sooooo..... what do you want to do?" and I was like "I'm transferring this to Walmart because I know they have Teva" (that was before the Dexedrine incident...)

That makes sense and likely explains why they couldn't get Zenzedi. But Zenzedi isn't that expensive, and my insurance covers it, so I dunno... *shrugs* My pdoc is against prescribing d-amp now anyway and can't get her to do it anymore, so whatever. lol. Yeah my friend's pharmacy, also a family pharmacy, blatantly said "we don't accept GoodRX coupons" when I went with him the first time he went to the doctor for an antidepressant.

Wow, that's pretty informative, thanks for mentioning all that!

16 minutes ago, JustNuts said:

Bluntly put, your pdoc is an idiot. There is nothing magical about pure d-amp or d-amp spansules that makes it worse for the heart than much higher doses of d-amp combined with a fricking PNS stimulant (levoamphetamine). If anything the d-amp is arguably better for the heart than the MAS due to it essentially being a purely CNS stimulant...

No, she's not an idiot. While I agree with what you're saying, and I have argued with her several times about the matter, even using color-coded spreadsheets to explain my ideas, she still maintains that going above Dexedrine 30 mg is more dangerous than going way high on Adderall (60 mg and above, and I was surprised she went above 60 mg when she did... which was once only). I have argued the same about d-amp being better than MAS on the heart being that it's purely a CNS stimulant, but she consistently disagrees. While she has a lot of years of experience behind her, I have found nothing that she said about it that holds water, but I certainly would not call her an idiot. She is, in fact, a magnificent pdoc who cares deeply about me and my family (who also see her). She's just really, really conservative when it comes to certain meds, stimulants being among them, and especially since her husband died last summer of sudden cardiac death (she's ultra scared to put me on anything cardiac side effect-related, I think because she genuinely cares about me).

I may be in luck though. I have a sleep doctor now, who I'm thinking, depending on his receptiveness to suggestions and prescribing habits, about letting control my stimulant prescriptions. I saw him just today and he put me on Adderall 40 mg, knowing my pdoc had me on 60 mg already... not sure why... I guess he wants to start somewhat low but somewhat high from his standpoint, then go from there. He did say that unfortunately, they can't prescribe supratherapeutic doses, but I have an idea about how to get around that. I was a little irritated that he rushed through the appointment so fast that I didn't get a say in what stimulant and how much of it I got, because I was going to tell him that I respond to Dexedrine better and have fewer side effects from it (racing heart, e.g.). While it was only my second appointment with him, he already knew from my medical chart that I was clinically OCD and knew a lot about medications (XD), so maybe that weighs positively in my favor for suggestibility? But what I was going to suggest to him, depending on if he trusted me, was, because I've only ever been prescribed 30 mg Dex Spansules (if I'm not mistaken, equivalent to 40 mg Adderall? Which is what he prescribed to me anyway...), to be prescribed Dexedrine Spansules 60 mg/day either as 6x10 mg or 4x15 mg (his choice) PLUS Dexedrine IR 5-10 mg tabs (his choice) in any range from 10-60 mg (depending on how much he trusts me) and let me keep a spreadsheet (I'll make some fucking spreadsheets if you don't watch out... :P) keeping track of Spansule, IR, and total dose, and start from 30 mg, and titrate up anywhere from 2.5-10 mg increments per day, every few days, or week (his decision), and depending on where I find my sweet spot (wherever that is, between 30-120 mg or however much he allows me), I would report back to him with my spreadsheet, and depending on that and his judgement, he could prescribe me Spansules and/or IR if needed. See, it's not just severe ADHD I need stims for, it's also idiopathic hypersomnia. I always want a nap, and end up sleeping half the day away, even on max dose Adderall. That's why I'm so adamant about Dexedrine (more potent CNS stimulant) doses greater than 30 mg (greater than 40 mg Adderall equiv.), and supratherapeutic doses. I have never been susceptible to abusing stimulants. For crying out loud, I took Desoxyn TWICE and never once felt inclined to increase the dose on my own or do something stupid like snort it or whatever. If anything, I was extremely cautious with it, and eventually wanted off of it because I didn't like the way I felt on it, and the second try I had a negative reaction so I'm never taking it again.

33 minutes ago, JustNuts said:

but she's already prescribing a supratherepeutic dose of Adderall, so she can't use that argument at all and clearly already considers supratherapeutic doses to be an acceptable risk.

Yes, she once prescribed me 90 mg Adderall XR, but only once. She backed me off to 60 mg, but kept me there for a long time.

34 minutes ago, JustNuts said:

The real reasons of course are likely the combination of misremembered details about cardiovascular risks of ADHD medications, lack of familiarity with prescribing d-amp, much more familiarity with prescribing MAS, and unfortunately all too typical levels of ignorance about psychopharmacology among the people who are supposed to have effectively/essentially specialized in practicing psychopharmacology...

I guarantee she was practicing in the days when Adderall wasn't even out and Dexedrine was what was used. I don't question that she knows how to use it, I just question whether she really grasps the fact that she is prescribing doses of Adderall with more dextroamphetamine in it than she is prescribing me in Dexedrine. Sure it's divided between different amphetamine salts with MAS, and in Dexedrine, it's just dextroamphetamine sulfate, but does that make a difference?

My theory is that Dexedrine has been around longer and was infamously abused for decades and therefore gained a negative reputation, and had Adderall came out at the same time Dexedrine did, it would have had the same thing happen to it. I personally believe Adderall is just as abusable or "likable" or "seekable" as Dexedrine. I could be wrong, but that's just what I think. And Vyvanse can take a hike, it did nothing for me but crash in the middle of the day with a huge dysphoric teary mess every single day, and even at 70 mg, didn't confer nearly the same stimulation that Adderall 40 mg or Dexedrine 30 mg did. I know Vyvanse's dextroamphetamine equivalencies are funky, but I must've metabolized it very strangely. But she's all about some Vyvanse. She's more than happy to give you 30-50 mg Vyvanse. (I love her still, she has seen me for hours at a time until midnight before several times. I will continue to see her until she retires, I believe).

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4 hours ago, mikl_pls said:

I was extremely surprised too! I live in a rather small town in which crystal meth is very prominent... And you're right, Desoxyn is not cheap. Dex IR and Spansules are both cheaper than Desoxyn, but Dex Spansules come close to the cost of Desoxyn depending on the dosage.

I'm very tolerant about my current family-owned pharmacy when it comes to them not having enough of or not having a medicine in stock because they always overnight the med to be ready for the next business day. CVS would be like, "we'll order it when and if we feel like it, and oh btw we forgot to order it, so it'll be here next week instead of this week after you waited 5 days when we told you it'd be 3 days until it's here, so you get to wait a total of 1 and a half weeks, you're okay with that right?" I was glad my insurance stopped covering CVS and forced me to start going to another pharmacy despite being friends with almost everyone there.

This definitely my experience so far. One thing I haven't tried but fear still won't be possible is requesting specific generic brands... like Sandoz oxazepam works better for me than Activis oxazepam, and I've just been putting up with Activis from both CVS and Jones. CVS made an attempt to order Sandoz, but their supplier sent Activis anyway with a big middle finger. Same as when I tried to get Teva lamotrigine (instead of Cadista garbage that they get), their supplier sent the regular Cadista 3 times in a row, the last two times the had it overnighted, and the third time they were like, "sooooo..... what do you want to do?" and I was like "I'm transferring this to Walmart because I know they have Teva" (that was before the Dexedrine incident...)

No, she's not an idiot. While I agree with what you're saying, and I have argued with her several times about the matter, even using color-coded spreadsheets to explain my ideas, she still maintains that going above Dexedrine 30 mg is more dangerous than going way high on Adderall (60 mg and above, and I was surprised she went above 60 mg when she did... which was once only). I have argued the same about d-amp being better than MAS on the heart being that it's purely a CNS stimulant, but she consistently disagrees. While she has a lot of years of experience behind her, I have found nothing that she said about it that holds water, but I certainly would not call her an idiot. She is, in fact, a magnificent pdoc who cares deeply about me and my family (who also see her). She's just really, really conservative when it comes to certain meds, stimulants being among them, and especially since her husband died last summer of sudden cardiac death (she's ultra scared to put me on anything cardiac side effect-related, I think because she genuinely cares about me).

I may be in luck though. I have a sleep doctor now, who I'm thinking, depending on his receptiveness to suggestions and prescribing habits, about letting control my stimulant prescriptions. I saw him just today and he put me on Adderall 40 mg, knowing my pdoc had me on 60 mg already... not sure why... I guess he wants to start somewhat low but somewhat high from his standpoint, then go from there. He did say that unfortunately, they can't prescribe supratherapeutic doses, but I have an idea about how to get around that. I was a little irritated that he rushed through the appointment so fast that I didn't get a say in what stimulant and how much of it I got, because I was going to tell him that I respond to Dexedrine better and have fewer side effects from it (racing heart, e.g.). While it was only my second appointment with him, he already knew from my medical chart that I was clinically OCD and knew a lot about medications (XD), so maybe that weighs positively in my favor for suggestibility? But what I was going to suggest to him, depending on if he trusted me, was, because I've only ever been prescribed 30 mg Dex Spansules (if I'm not mistaken, equivalent to 40 mg Adderall? Which is what he prescribed to me anyway...), to be prescribed Dexedrine Spansules 60 mg/day either as 6x10 mg or 4x15 mg (his choice) PLUS Dexedrine IR 5-10 mg tabs (his choice) in any range from 10-60 mg (depending on how much he trusts me) and let me keep a spreadsheet (I'll make some fucking spreadsheets if you don't watch out... :P) keeping track of Spansule, IR, and total dose, and start from 30 mg, and titrate up anywhere from 2.5-10 mg increments per day, every few days, or week (his decision), and depending on where I find my sweet spot (wherever that is, between 30-120 mg or however much he allows me), I would report back to him with my spreadsheet, and depending on that and his judgement, he could prescribe me Spansules and/or IR if needed. See, it's not just severe ADHD I need stims for, it's also idiopathic hypersomnia. I always want a nap, and end up sleeping half the day away, even on max dose Adderall. That's why I'm so adamant about Dexedrine (more potent CNS stimulant) doses greater than 30 mg (greater than 40 mg Adderall equiv.), and supratherapeutic doses. I have never been susceptible to abusing stimulants. For crying out loud, I took Desoxyn TWICE and never once felt inclined to increase the dose on my own or do something stupid like snort it or whatever. If anything, I was extremely cautious with it, and eventually wanted off of it because I didn't like the way I felt on it, and the second try I had a negative reaction so I'm never taking it again.

Yes, she once prescribed me 90 mg Adderall XR, but only once. She backed me off to 60 mg, but kept me there for a long time.

I guarantee she was practicing in the days when Adderall wasn't even out and Dexedrine was what was used. I don't question that she knows how to use it, I just question whether she really grasps the fact that she is prescribing doses of Adderall with more dextroamphetamine in it than she is prescribing me in Dexedrine. Sure it's divided between different amphetamine salts with MAS, and in Dexedrine, it's just dextroamphetamine sulfate, but does that make a difference?

My theory is that Dexedrine has been around longer and was infamously abused for decades and therefore gained a negative reputation, and had Adderall came out at the same time Dexedrine did, it would have had the same thing happen to it. I personally believe Adderall is just as abusable or "likable" or "seekable" as Dexedrine. I could be wrong, but that's just what I think. And Vyvanse can take a hike, it did nothing for me but crash in the middle of the day with a huge dysphoric teary mess every single day, and even at 70 mg, didn't confer nearly the same stimulation that Adderall 40 mg or Dexedrine 30 mg did. I know Vyvanse's dextroamphetamine equivalencies are funky, but I must've metabolized it very strangely. But she's all about some Vyvanse. She's more than happy to give you 30-50 mg Vyvanse. (I love her still, she has seen me for hours at a time until midnight before several times. I will continue to see her until she retires, I believe).

Cash cost, post-insurance cost (copay/coins), or what the insurer actually pays? To give you an example, the cash cost for 90x 20mg Adderall IR is $124.49, my post-insurance cost (copay) is $10, and the insurer actually pays a further $36.42, making the actual total cost of the medication $46.42.

CVS is literally the worst pharmacy chain though, you can't really expect much out of them.

The one time I ever asked about a specific generic (it was for bupropion SR, they had just switched manufacturers from Sandoz to Solco and I started seeing bizarrely glaring negative changes in the medication's effects -- I severely doubted that the manufacturer switch would affect things, but after ruling out all reasonable alternate explanations as best as I could with no improvements, I was forced to assume that perhaps Solco's release mechanism was not quite up to snuff for whatever reason). Anyways, I asked about switching back (but not directly to the store - probably a mistake), and was told that it would be no problem to do that and that next time I filled they would use the old generic...of course next time when I filled they hadn't followed through with that, and by the time I realized this (well after leaving the pharmacy) I just gave up and decided it really wasn't worth the effort. In retrospect, I think I should have pushed harder, but the likelihood of a legitimate issue with a generic switch is so low that I didn't trust that was actually the issue, and I was too miserable to care.

(I have thought about asking to switch Adderall IR generics a number of times because the generic they use rapidly dissolves at a far too fast rate and is nauseatingly sweet, which has led to me gagging or even nearly vomiting on more than one occasion, but I don't really want to deal with trying to get that changed, even more so than with any other drug because it's a CII and my pharmacist is already doing me a big favor by partial filling it and running it through my insurer as a 30 day RX to partially bypass the QL)

I think I worded things a bit too harshly w.r.t. your pdoc -- sorry about that. It sounds like she's a great doctor outside of this one issue.

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On 7/7/2017 at 6:41 AM, JustNuts said:

CVS is literally the worst pharmacy chain though, you can't really expect much out of them.

Yes, I found this out through experience. :P But I put up with them for longer than I should've because I was friends with many of the pharm techs and the pharmacist was the father of one of my friends (until he retired, then things just went to hell).

On 7/7/2017 at 6:41 AM, JustNuts said:

The one time I ever asked about a specific generic (it was for bupropion SR, they had just switched manufacturers from Sandoz to Solco and I started seeing bizarrely glaring negative changes in the medication's effects -- I severely doubted that the manufacturer switch would affect things, but after ruling out all reasonable alternate explanations as best as I could with no improvements, I was forced to assume that perhaps Solco's release mechanism was not quite up to snuff for whatever reason). Anyways, I asked about switching back (but not directly to the store - probably a mistake), and was told that it would be no problem to do that and that next time I filled they would use the old generic...of course next time when I filled they hadn't followed through with that, and by the time I realized this (well after leaving the pharmacy) I just gave up and decided it really wasn't worth the effort. In retrospect, I think I should have pushed harder, but the likelihood of a legitimate issue with a generic switch is so low that I didn't trust that was actually the issue, and I was too miserable to care.

Are you currently about to get generic brands of your choice at your current pharmacy? If so, where do you go? (If it's Walgreens I'm going to have to go out of town for that... lol)

On 7/7/2017 at 6:41 AM, JustNuts said:

(I have thought about asking to switch Adderall IR generics a number of times because the generic they use rapidly dissolves at a far too fast rate and is nauseatingly sweet, which has led to me gagging or even nearly vomiting on more than one occasion, but I don't really want to deal with trying to get that changed, even more so than with any other drug because it's a CII and my pharmacist is already doing me a big favor by partial filling it and running it through my insurer as a 30 day RX to partially bypass the QL)

OMG the QL is such a pain in the ass! My insurance company reduced the QL of Adderall XR from 2/day to 1/day, so without a PA, you can only get 30 mg. Is your generic Adderall IR by any chance Barr?

On 7/7/2017 at 6:41 AM, JustNuts said:

I think I worded things a bit too harshly w.r.t. your pdoc -- sorry about that. It sounds like she's a great doctor outside of this one issue.

That's quite alright. I do understand where you're coming from, and at times I have been so frustrated about it I have considered switching pdocs, but I imagine many pdocs in the area wouldn't even prescribe Dexedrine. I think my sleep doctor would be more likely to prescribe Dexedrine, especially in the manner that I mentioned.

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On 7/6/2017 at 3:43 AM, mikl_pls said:

CVS never stocked Dexedrine for me and the pharmacy techs had trouble even identifying what the generic for Dexedrine Spansules were (I overheard them saying "I think this is just Adderall XR..." but they finally figured it out, but now they think it's methamphetamine, which is Desoxyn). When I was taking Desoxyn, after a few months of taking it, they started actually stocking it, but I took Dexedrine much longer than I took Desoxyn and they never ever started stocking Dexedrine.

This happened exactly to me. I fought with the pharmacist about this being Dexedrine not Adderall XR, and eventually asked for my prescription back and went elsewhere. No where I go has them in stock. The only pharmacies to have them in stock are the ones I previously filled from, therefore they have remaining medication from what they use for my prescription. 

On 7/7/2017 at 3:10 AM, mikl_pls said:

My theory is that Dexedrine has been around longer and was infamously abused for decades and therefore gained a negative reputation, and had Adderall came out at the same time Dexedrine did, it would have had the same thing happen to it. I personally believe Adderall is just as abusable or "likable" or "seekable" as Dexedrine. 

I definitely think Dexedrine got a bad reputation but can't speak much on it because it occurred during the times I was too young. In my opinion, Adderall is more abusable then Dexedrine, just because with Adderall there is that PNS stimulation, excessive talking, and I had that experience with Vyvanse 70mg also, being very speedy and almost manic. I believe Dexedrine to be the smoother of the three and I like the fact that I can take my medication sometimes and not have to "feel it" to understand and realize it is helping.

 

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10 hours ago, mmaryland said:

I definitely think Dexedrine got a bad reputation but can't speak much on it because it occurred during the times I was too young. In my opinion, Adderall is more abusable then Dexedrine, just because with Adderall there is that PNS stimulation, excessive talking, and I had that experience with Vyvanse 70mg also, being very speedy and almost manic. I believe Dexedrine to be the smoother of the three and I like the fact that I can take my medication sometimes and not have to "feel it" to understand and realize it is helping.

Interesting you felt that with Vyvanse as (I'm sure you know) it's a pro-drug for dextroamphetamine with the highest dose (70 mg) being equivalent to about 20.636-28.301 mg dextroamphetamine (depending on how you calculate it).

But I definitely agree that Adderall, if any of them, would be more abusable. I don't "feel" Dexedrine nearly as much as I feel Adderall. Adderall is more "likable" and in my opinion subsequently more "seekable." Then again, not many people (like those in college who buy stims off people for studying) know about Dexedrine or Desoxyn.

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5 minutes ago, mikl_pls said:

Interesting you felt that with Vyvanse as (I'm sure you know) it's a pro-drug for dextroamphetamine with the highest dose (70 mg) being equivalent to about 20.636-28.301 mg dextroamphetamine (depending on how you calculate it).

But I definitely agree that Adderall, if any of them, would be more abusable. I don't "feel" Dexedrine nearly as much as I feel Adderall. Adderall is more "likable" and in my opinion subsequently more "seekable." Then again, not many people (like those in college who buy stims off people for studying) know about Dexedrine or Desoxyn.

Yea Vyvanse made me extremely euphoric and stimulated, I would say a bit more so than adderall did. I can take adderall 60mg XR and feel slightly stimulated but more zombified. With Vyvanse, its bouncing off the walls energy and talkativeness, etc.

 It's concerning that too many patients are given Adderall without ever the consideration of Dexedrine. I can agree that people who are not prescribed ADHD meds have no idea what Dexedrine is. I have very rarely heard of Desoxyn prescribed in my life, if ever.

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19 minutes ago, mmaryland said:

It's concerning that too many patients are given Adderall without ever the consideration of Dexedrine. I can agree that people who are not prescribed ADHD meds have no idea what Dexedrine is. I have very rarely heard of Desoxyn prescribed in my life, if ever.

Yeah, many times Dexedrine, if it is brought up, is dismissed by a majority of prescribers because of the reputation/stigma. But luckily my pdoc didn't dismiss it. She's just ultra-conservative to the point where it doesn't make sense when it comes to dosing.

I've taken Desoxyn twice, the first time being okay but eventually wanting off of it, the second time having a negative reaction from it and getting off of it and bringing it back to my pdoc so she could properly dispose of it.

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On 7/8/2017 at 0:02 PM, mikl_pls said:

Are you currently about to get generic brands of your choice at your current pharmacy? If so, where do you go? (If it's Walgreens I'm going to have to go out of town for that... lol)

OMG the QL is such a pain in the ass! My insurance company reduced the QL of Adderall XR from 2/day to 1/day, so without a PA, you can only get 30 mg. Is your generic Adderall IR by any chance Barr?

That's quite alright. I do understand where you're coming from, and at times I have been so frustrated about it I have considered switching pdocs, but I imagine many pdocs in the area wouldn't even prescribe Dexedrine. I think my sleep doctor would be more likely to prescribe Dexedrine, especially in the manner that I mentioned.

I haven't tried getting a specific generic brand again since the last attempt. The only pharmacy I use is Walgreens.

I'd try to get the QL override approved, but at this point I'd have to have my pdoc send in another fricking PA, wait for that to get denied, then appeal it, which takes forever and is a PITA, and I don't even know if we'll still have the same insurer next year, so I'm not sure that it's worth the effort at all. If I knew we were definitely going to have the same insurer next year than I'd have appealed it already since it's such a huge headache.

Yep, it's the 20 mg Barr MAS IR generic. Absolutely disgusting taste.

If the sleep doc has experience treating narcolepsy than they'd be used to prescribing higher doses of d-amp and shouldn't have an issue with it, but otherwise IDK if they'd be willing.

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On 7/11/2017 at 11:14 AM, mmaryland said:

 It's concerning that too many patients are given Adderall without ever the consideration of Dexedrine. I can agree that people who are not prescribed ADHD meds have no idea what Dexedrine is. I have very rarely heard of Desoxyn prescribed in my life, if ever.

Vyvanse is very popular though and that's the same drug (just as a prodrug).

Personally d-amp did not agree with me, even as just a bit of IR augmenting the MAS XR towards the end of the day - it consistently made me feel worse when it kicked in (depressed, miserable, even suicidal). It seems that I need the norepinephrine component for usable effects.

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17 minutes ago, JustNuts said:

Vyvanse is very popular though and that's the same drug (just as a prodrug).

Personally d-amp did not agree with me, even as just a bit of IR augmenting the MAS XR towards the end of the day - it consistently made me feel worse when it kicked in (depressed, miserable, even suicidal). It seems that I need the norepinephrine component for usable effects.

It's interesting how Vyvanse is the prodrug of Dexedrine but they both have completely different effects on me. Dexedrine feels so much smoother than Vyvanse, and doesn't make my chest as tight. Vyvanse also makes me feel terrible during the comedown.

For me, I am the opposite of you. I get more depression and comedown feelings after taking Adderall XR or anything with l-amp in it. With Dexedrine, I don't "feel" it as much and the comedown is more gradual and a lot less noticeable, for me at least, without leaving me feeling shitty. Vyvanse wasn't doing this as much as Adderall, but still was giving me depressed mood, anhedonia, irritability. The switch to Dexedrine was definitely a great decision in my experience/

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Last night I tried yet again and failed yet again to get my pdoc to prescribe me an equipotent dose of Dexedrine to Adderall 60 mg (45 mg). Her excuse this time was, (1) we don't want to change you around too much, to which I said, "yes, but it's going to have less physical side effects on me," to which she replied with, (2) it's rawer, IOW, it hits more dopamine receptor subtypes than Adderall; when I asked her why, she said that Adderall is cleaner than Dexedrine, and when I asked how it's cleaner, she just repeated that it hits less dopamine receptor subtypes and doesn't cause brain damage at higher doses, THEN she did something she's never done before, which was pull out the "well, with 12 years of education and [...] years of clinical experience, one comes to know... etc." card, which actually pissed me off—I could feel myself clenching my teeth and clenching my hands and toes. From now on for the time being, I'm just going to differ to my sleep doctor and see what he'll do. He only prescribed me 40 mg Adderall, but I'll ask for Dexedrine next time and tell him my pdoc prescribed me 60 mg and I'd like to match that in Dexedrine or more. Then again, I live in fucking Alabama in a part of the state where crystal meth is a huge deal, so Dexedrine is a BIIIIIG no-no. "Desoxyn? What's that? I've never heard of that. Dexedrine? You're the spawn of Satan!" I still love my pdoc because she was willing to see me last minute, and I highly doubt any pdoc in the area would even remotely consider prescribing Desoxyn or Dexedrine like she has. But I just might start considering seeing someone else, just because of that card she pulled on me. My brother has one and I may ask him to ask for me if he'd be willing to prescribe me Dexedrine.

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Posted (edited)

1 hour ago, mikl_pls said:

Last night I tried yet again and failed yet again to get my pdoc to prescribe me an equipotent dose of Dexedrine to Adderall 60 mg (45 mg). Her excuse this time was, (1) we don't want to change you around too much, to which I said, "yes, but it's going to have less physical side effects on me," to which she replied with, (2) it's rawer, IOW, it hits more dopamine receptor subtypes than Adderall; when I asked her why, she said that Adderall is cleaner than Dexedrine, and when I asked how it's cleaner, she just repeated that it hits less dopamine receptor subtypes and doesn't cause brain damage at higher doses, THEN she did something she's never done before, which was pull out the "well, with 12 years of education and [...] years of clinical experience, one comes to know... etc." card, which actually pissed me off—I could feel myself clenching my teeth and clenching my hands and toes. From now on for the time being, I'm just going to differ to my sleep doctor and see what he'll do. He only prescribed me 40 mg Adderall, but I'll ask for Dexedrine next time and tell him my pdoc prescribed me 60 mg and I'd like to match that in Dexedrine or more. Then again, I live in fucking Alabama in a part of the state where crystal meth is a huge deal, so Dexedrine is a BIIIIIG no-no. "Desoxyn? What's that? I've never heard of that. Dexedrine? You're the spawn of Satan!" I still love my pdoc because she was willing to see me last minute, and I highly doubt any pdoc in the area would even remotely consider prescribing Desoxyn or Dexedrine like she has. But I just might start considering seeing someone else, just because of that card she pulled on me. My brother has one and I may ask him to ask for me if he'd be willing to prescribe me Dexedrine.

My present pdoc, who I have seen for 11 years has allowed me to try or had me on all the d-amphetamine products on the market and Adderall. It does not seem to matter which as long as it works.  He says "Some do better on dexedrine".

Edited by notloki
add He says "Some do better on dexedrine".

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3 hours ago, mikl_pls said:

Last night I tried yet again and failed yet again to get my pdoc to prescribe me an equipotent dose of Dexedrine to Adderall 60 mg (45 mg). Her excuse this time was, (1) we don't want to change you around too much, to which I said, "yes, but it's going to have less physical side effects on me," to which she replied with, (2) it's rawer, IOW, it hits more dopamine receptor subtypes than Adderall; when I asked her why, she said that Adderall is cleaner than Dexedrine, and when I asked how it's cleaner, she just repeated that it hits less dopamine receptor subtypes and doesn't cause brain damage at higher doses, THEN she did something she's never done before, which was pull out the "well, with 12 years of education and [...] years of clinical experience, one comes to know... etc." card, which actually pissed me off—I could feel myself clenching my teeth and clenching my hands and toes. 

With my 1st pdoc it went the same way trying to get Dexerdrine. "Adderall is newer, better, and many of my patients do well on it.....Vyvanse last much longer and is therefore better for ADHD than Dexedrine" but he never went into details about dopamine receptor subtypes or any pharmacological reasons as to why he wouldn't let me try Dexedrine. I could be wrong but it would seem like Dexedrine would be cleaner due to the lack of l-amp and hitting of norepinephrine receptors, but trust your pdoc on that not me. As for the brain damage, wouldn't Adderall be just as likely to cause it, theoretically, as Dexedrine given they both contain d-amp....Although Dexedrine is purely d-amp, equivalent doses to Adderall would essentially contain the same amount of d-amp. Adderall gives more adrenal stimulation also since it is more noradrenergic. Now this may be helpful for some with ADHD inattentive, but others are bothered by its effects (like me and you). As far as dosing goes, Dexedrine can be dosed lower than Adderall to achieve the same results, and with lower doses comes less side effects. I take usuaully 50mg Dexedrine (Zenzedi is dexedrine) but often take only 30mg Dexedrine Spansules with great success. On the other hand, taking Adderall 30mg XR is almost placebo to me, and even on 60mg XR I was not getting full ADHD coverage.

After being bounced from Adderall XR back to Vyvanse several times I decided it was time to see a new psychiatrist. I used the same reason as you maybe the 3rd time I saw my new psychiatrist and without suggestion from me she goes "well there is Dexedrine we can try if you're having too much peripheral side effects with the Vyvanse and Adderall, but it is shorter acting than most ADHD medications." It wasn't a fight or debate at all, like @notloki said, I was allowed to try the various amphetamine-based medications, and other meds like benzos, z-drugs, antipsychotics, mood stabilizers, etcetera, until we found the medications that worked for me. 

I agree with your pdoc that changing meds around too much/often is not good, but it is essential while you are trying to find a cocktail that works for you. Too much change, like 3-4 meds change at a single time, is definitely not a good ideal. However, what is the harm in changing 1 medication at a time? This way you and your doctor both can figure out whether this 1 medication works for you or if its side effects make it a no-go.

BTW I see in your signature than you are on Dexedrine 15mg bid, is this true? if so, who prescribed this and does your regular pdoc know? 

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2 hours ago, mmaryland said:

With my 1st pdoc it went the same way trying to get Dexerdrine. "Adderall is newer, better, and many of my patients do well on it.....Vyvanse last much longer and is therefore better for ADHD than Dexedrine" but he never went into details about dopamine receptor subtypes or any pharmacological reasons as to why he wouldn't let me try Dexedrine. I could be wrong but it would seem like Dexedrine would be cleaner due to the lack of l-amp and hitting of norepinephrine receptors, but trust your pdoc on that not me. As for the brain damage, wouldn't Adderall be just as likely to cause it, theoretically, as Dexedrine given they both contain d-amp....Although Dexedrine is purely d-amp, equivalent doses to Adderall would essentially contain the same amount of d-amp. Adderall gives more adrenal stimulation also since it is more noradrenergic. Now this may be helpful for some with ADHD inattentive, but others are bothered by its effects (like me and you). As far as dosing goes, Dexedrine can be dosed lower than Adderall to achieve the same results, and with lower doses comes less side effects. I take usuaully 50mg Dexedrine (Zenzedi is dexedrine) but often take only 30mg Dexedrine Spansules with great success. On the other hand, taking Adderall 30mg XR is almost placebo to me, and even on 60mg XR I was not getting full ADHD coverage.

I argued this exact point with her back and forth in an endless loop until she basically bared her teeth at me and waved her clinical experience in my face. Apparently I made her very sore, cornered her, and challenged her, and she didn't like it. She also said something, I can't remember verbatim exactly, but essentially it boiled down to "it's not for you to know that about these medications," IOW "let me be the doctor." Kinda crushed my aspirations of becoming a psychiatrist. I texted her to let her know that. No response. Maybe a little passive aggressive, but I communicate the best I can.

2 hours ago, mmaryland said:

After being bounced from Adderall XR back to Vyvanse several times I decided it was time to see a new psychiatrist. I used the same reason as you maybe the 3rd time I saw my new psychiatrist and without suggestion from me she goes "well there is Dexedrine we can try if you're having too much peripheral side effects with the Vyvanse and Adderall, but it is shorter acting than most ADHD medications." It wasn't a fight or debate at all, like @notloki said, I was allowed to try the various amphetamine-based medications, and other meds like benzos, z-drugs, antipsychotics, mood stabilizers, etcetera, until we found the medications that worked for me.

That's fantastic. I hope to find a pdoc like that some day.

2 hours ago, mmaryland said:

I agree with your pdoc that changing meds around too much/often is not good, but it is essential while you are trying to find a cocktail that works for you. Too much change, like 3-4 meds change at a single time, is definitely not a good ideal. However, what is the harm in changing 1 medication at a time? This way you and your doctor both can figure out whether this 1 medication works for you or if its side effects make it a no-go.

1

The was using the "changing meds" as an excuse. The has used everything from "it's too hard on your heart" to, now, "Adderall is more pure" and "Dexedrine causes brain damage." I call bullshit. It's okay for a doctor to say "I don't know, let me do some research on that." But in her mind, I'm sure she believes she has DONE the research and doesn't NEED to do anymore.

2 hours ago, mmaryland said:

BTW I see in your signature than you are on Dexedrine 15mg bid, is this true? if so, who prescribed this and does your regular pdoc know?

Oh that was leftover from another time I was taking Dexedrine... I need to take that off.

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16 hours ago, mikl_pls said:

Last night I tried yet again and failed yet again to get my pdoc to prescribe me an equipotent dose of Dexedrine to Adderall 60 mg (45 mg). Her excuse this time was, (1) we don't want to change you around too much, to which I said, "yes, but it's going to have less physical side effects on me," to which she replied with, (2) it's rawer, IOW, it hits more dopamine receptor subtypes than Adderall; when I asked her why, she said that Adderall is cleaner than Dexedrine, and when I asked how it's cleaner, she just repeated that it hits less dopamine receptor subtypes and doesn't cause brain damage at higher doses, THEN she did something she's never done before, which was pull out the "well, with 12 years of education and [...] years of clinical experience, one comes to know... etc." card, which actually pissed me off—I could feel myself clenching my teeth and clenching my hands and toes. From now on for the time being, I'm just going to differ to my sleep doctor and see what he'll do. He only prescribed me 40 mg Adderall, but I'll ask for Dexedrine next time and tell him my pdoc prescribed me 60 mg and I'd like to match that in Dexedrine or more. Then again, I live in fucking Alabama in a part of the state where crystal meth is a huge deal, so Dexedrine is a BIIIIIG no-no. "Desoxyn? What's that? I've never heard of that. Dexedrine? You're the spawn of Satan!" I still love my pdoc because she was willing to see me last minute, and I highly doubt any pdoc in the area would even remotely consider prescribing Desoxyn or Dexedrine like she has. But I just might start considering seeing someone else, just because of that card she pulled on me. My brother has one and I may ask him to ask for me if he'd be willing to prescribe me Dexedrine.

9 hours ago, mikl_pls said:

I argued this exact point with her back and forth in an endless loop until she basically bared her teeth at me and waved her clinical experience in my face. Apparently I made her very sore, cornered her, and challenged her, and she didn't like it. She also said something, I can't remember verbatim exactly, but essentially it boiled down to "it's not for you to know that about these medications," IOW "let me be the doctor." Kinda crushed my aspirations of becoming a psychiatrist. I texted her to let her know that. No response. Maybe a little passive aggressive, but I communicate the best I can.

That's fantastic. I hope to find a pdoc like that some day.

The was using the "changing meds" as an excuse. The has used everything from "it's too hard on your heart" to, now, "Adderall is more pure" and "Dexedrine causes brain damage." I call bullshit. It's okay for a doctor to say "I don't know, let me do some research on that." But in her mind, I'm sure she believes she has DONE the research and doesn't NEED to do anymore.

Oh that was leftover from another time I was taking Dexedrine... I need to take that off.

Lol, so now the outright bizarre mixture of literally four different amphetamine salts with an overall 3:1 d-amp/l-amp ratio is "cleaner" than the pure d-amp, riiiiigh. Makes total sense /s.

No neurotoxicity with d-amp or l-amp. Both have similar (small) potential risks of neurotoxicity at truly absurd doses (ones only seen with very major abuse). Only methamphetamine is neurotoxic irregardless of dose.

d-amp hits fewer receptor subtypes than l-amp IIRC due to the greater DA effects and lesser NE effects, although it's been quite a while since I reviewed the fine details of amphetamine's pharmacology so perhaps I'm wrong, but I'm pretty confident that I'm right about this. If you try comparing it to a different stim like MPH or to something else entirely then yeah it gets complicated fast since other stuff hits different areas of the brain in different ways, but d-amp and l-amp have much more minor differences in localization.

Docs pulling the clinical experience/professional training card as an unjustified cop-out when they don't want to justify/explain their questionable actions, POV, etc and/or won't listen to any input (or even questions!) from you because "you're the patient, not the doctor" always piss me off massively. My current pdoc is really great about all that stuff (not to mention very enthusiastic and knowledgeable), but I've had too many run-ins with bad pdocs in the past and am not optimistic at all about my chances of finding another pdoc as good as this one when we eventually move.

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