Were you previously using an amphetamines or cocaine? If so, it is important to talk to your doctor about your use of substances, why you used, how much you used. Adderall is a controlled substance and amphetamines have a well-documented history of abuse. But, you should always be honest so you can be prescribed what is best, not what you may want. It is fine to mention Adderall and/or Dexedrine along with your concerns but don't walk into the doctor's office thinking to yourself "I want Adderall," think "I want to get better." When you do that your treatment will be much better.
It is also important to note that legally a doctor may prescribe controlled substances to people with a known history of illegal substance use, abuse, dependency, and addiction. Medical associations including The American Academy of Pediatrics, The American Psychiatric Association, The American Medical Association, and many other medical boards and agencies around the world clearly indicate that stimulant medications (amphetamines and methylphenidate) can be used in people with a history of substance abuse successfully.
Provigil (modafinil) is a non-amphetamine stimulant with significantly fewer psychotropic effects of amphetamines has been successfully used in treating some cases of ADHD, typically refractory cases. Like Wellbutrin (bupropion) is not FDA approved but it may be a good option for some people, including those with a history of substance abuse. It is a schedule IV controlled substance in The United States. Valium (diazepam), Darvocet/Darvon (propoxyphene), Miltown (meprobamate), chloral hydrate, Ambien (zolpidem), Adipex-P (phentermine) are examples of other schedule IV drugs. Most other nations do not list Provigil as a controlled substance.
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When I first was diagnosed with ADHD about two months ago my doctor asked me if I'd used Ritalin (methylphenidate) as a study aid prior to, and also what effects it had; I told him that I'd not used Ritalin, but had used Adderall and proceeded to explain the effects I'd noticed as honestly as I could recall. He was in no way upset, angry, or condemning of this; he proceeded to go ahead and put me on Adderall since he felt, given my past experiences as I'd recounted to him, it would be an effective course of action.
It is common that people try Adderall or Ritalin and find many symptoms they once had disappear. Often people try to get treatment only after a friend gave them a pill. But most people focus better on stimulants so it can be hard to determine if the reaction was due to treating ADHD or the stimulating nature of amphetamines. And doctors, especially psychiatrists, greatly appreciate honesty since they need the big picture and the tiny fragments.
My husband's doctor knew he had a history of substance abuse and first prescribed him Strattera (atomoxetine), and it didn't work so she prescribed amphetamines. Explain to your doctor why you tried to self medicate. If you do have a history of amphetamine abuse and dependence and you believe that you will end up abusing stimulant medications express these concerns to your doctor and ask about non-addictive drugs like Strattera (atomoxetine) or Wellbutrin (bupropion), which is not approved for ADHD and is used off-label.
Treatment of ADHD with legally prescribed stimulants has indicated a significantly reduced chance of substance abuse and behavioral problems in people with ADHD.
Sometimes, it's only after someone experiences an atypical reaction to an illegal drug that they are correctly diagnosed with ADHD. If you have used a "street" stimulant such as methamphetamine and experience a calming effect rather than the euphoria your friends describe, there is a possibility you could have ADHD but only a doctor can make a diagnosis.
Although some people may use a "street" drug and that leads them to an ADHD diagnosis however more often they just continue using the drugs illegally.
Studies have shown that people with ADHD, bipolar, and other psychiatric disorders have higher rates of substance abuse. Just because you've used drugs in the past doesn't mean you can't get the proper treatment, which may or may not include stimulant medications.
Starting doses of prescription amphetamines and methylphenidate.
Note some of these drugs are not available in all countries and guidelines vary by country. These are US and Canadian guidelines. All "maximum" doses are guidelines and doctors may prescribe larger amounts ("off label use") as they see fit. These are the doses for ADHD and do not include guidelines for narcolepsy, a sleeping disorder many of these drugs are approved for which may require larger doses.
Adderall (mixed amphetamine salts)
Dosage forms: 5, 7.5, 10, 12.5, 15, 20, and 30 mg tablets
Start 5 mg twice daily; the dose may be increased by up to 5 mg/day. The technical maximum dose is 40 mg/day in 2-3 divided doses.
Adderall XR (mixed amphetamine salts extended-release)
Dosage forms: 5, 10, 15, 20, 25, 30 mg capsules
Start 20 mg capsule in the morning, may increase by 10 mg/day. The technical maximum dose is 40 mg/day. People rarely respond to a dose above 40 mg.
Dosage forms: 20, 30, 40, 50, 60, 70 mg capsules
Start 30 mg in the morning, maximum dose 70 mg/day
Dosage forms: 5, 10 mg tablets
Start 5 mg twice daily, maximum dose 60 mg/day in 2-3 divided doses.
Dexedrine Spansules (dextroamphetamine extended-release)
Dosage forms: 5, 10, 15 mg capsules
Start 5-10 mg in the morning or 5 mg twice daily, maximum dose 60 mg/day in 1-2 divided doses.
Dosage forms: 5 mg tablets
Start 5 mg twice daily, increase as need to up to 20-25 mg/day in two or three divided doses.
Note: Desoxyn is a form of methamphetamine and it not commonly prescribed although it is legal in The United States. In Canada methamphetamine is illegal and not a prescription medication.
Dosage forms: 5, 10, 20 mg tablets
Start 5-15 mg 2-3 times daily, maximum dose 60 mg/day.
Dosage forms: 2.5, 5 , 10 mg tablets
Start 2.5-10 mg twice daily, maximum dose 20 mg/day
Concerta (methylphenidate extended-release)
Dosage forms: 18, 27, 36, 54 mg
Start 1 tab in the morning; Initial starting dose: 18-36 mg, maximum 72 mg/day.
Information, by country, regarding legal control of amphetamines:
Remember all countries have different laws regarding drug use, level of control, and punishment.
Controlled Substances Act (United States)
Amphetamines and methylphenidate are schedule II controlled substances defined as:
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence
First Offenses: not more that 20 yrs. If death or serious injury, not less than 20 yrs, or more than Life. Fine $1 million if an individual, $5 million if not an individual.
Second Offense: Not more than 30 yrs. If death or serious injury, not less than life. Fine $2 million if an individual, $10 million if not an individual
Information from The DEA
Controlled Drugs and Substances Act (Canada)
Unlike other amphetamines, methamphetamine is a schedule I drug and it is not commercially available.
Other amphetamines (Adderall, Dexedrine, Vyvanse) and methylphenidate are schedule III drugs.
Punishment, when treated as an indictable offence-
Possession: Schedule III: Maximum 3 years imprisonment
Punishment, when treated as a summary conviction offence-
Maximum $1000 fine for first offence and/or maximum 6 months imprisonment.
Maximum $2000 fine for subsequent offence and/or maximum 1 year imprisonment.
Trafficking in schedule III drugs
Punishment, when treated as an indictable offence
Schedule III: Maximum 10 years imprisonment
Punishment, when treated as a summary conviction offence
Schedule III: Maximum 18 months imprisonment
Information from The Department of Justice Canada/Ministère de la Justice Canada
Misuse of Drugs Act (United Kingdom)
Amphetamines and methylphenidate are Class B drugs. Methamphetamine in any form and other amphetamines prepared by injection they are Class A drugs.
Punishment for Class B Drugs:
Possession Class B:
Crown Court Up to five years in prison or an unlimited fine or both
Magistrates 6 months/£5000 fine
Dealing Class B:
Crown Court Up to 14 years in prison or an unlimited fine or both.
Magistrates 6 months / £5000 fine
Information from The UK Home Office
Standard for the Uniform Scheduling of Drugs and Poisons (Australia)
Amphetamines (and methylphenidate) are Schedule 8 (S8) poisons and controlled drugs (possession without authority illegal)
Information from The Australian Government Department of Health and Ageing
United Nations: Green List Schedule II
Under international law and convention, amphetamines are schedule II drugs
Most countries abide by and have incorporated The Single Convention on Narcotic Drugs of 1961 and The Convention on Psychotropic Substances of 1971 into their own laws.
Adderall is a racemic mixture of levoamphetamine and dextroamphetamine, approximately ¾ of Adderall is dextroamphetamine and ¼ is levoamphetamine. The purest "speed" is dextroamphetamine, found in Adderall and found in Dexedrine, which is 100% dextroamphetamine. Although it may be technically valid to call Adderall or Dexedrine "speed" there is a subtle but significant difference, street "speed" is not pharmaceutical grade medication. As a result there are no contaminants and the focus of a pharmaceutical is on the effect it has in helping a problem, not getting someone high.
It is also critical to remember that nearly all of the most dangerous drugs are medically used. Heroin for example is just a bullet train for morphine, all heroin does is enter the brain rapidly and then heroin is rapidly metabolized into morphine (and two other less significant active metabolites). So as much as heroin is despised it is basically morphine and several controlled, double blind studies have shown an addict can't tell the difference from IV heroin and IV morphine.
My point being that just because many of these stimulants are "speed" does not say anything real about the drug, it simply feeds on mass hysteria.
Vyvanse (lisdexamfetamine) is a prodrug meaning that it does not have any pharmacologic activity until it is metabolized into its active metabolite, dextroamphetamine. Originally Shire, a British pharmaceutical company, claimed that the abuse potential of Vyvanse is much lower than other amphetamines however The FDA and DEA were not convinced and it has been placed under schedule II in The United States. For the most part it has only been post-marketing research that has definitively shown snorting or injecting can cause a high. Having said that, compared to any other amphetamine or methylphenidate drugs, it does have a significantly lower abuse liability.
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