John M. Talmadge, M.D.

A Blog Covering Many Topics

Adderall Time in Texas

We are six weeks into the academic year, and the requests for Adderall ("mixed amphetamine salts") are on the rise. As someone with considerable expertise and experience with ADD/ADHD, I know that stimulants can be very helpful for people who actually have attention deficit disorder. I worry, though, that a high percentage of people taking Adderall or other stimulants are simply looking for a "smart drug" or an energy boost. I also worry about diversion of these drugs, because medications in this class have considerable street value.
Here at the office, where I answer my own phone (and do my best to return all calls myself) I receive 4-5 calls weekly from individuals looking for a doctor who will prescribe Adderall or its long-acting cousin, Vyvanse (Lisdexamfetamine). Curious as it seems, many callers say that they are new to Dallas and need a new doctor to prescribe the medication. I say this is curious for two reasons. First, let's say that a doctor outside of Texas has a patient who is moving to Texas. One thing that prescribing doctor should do is help his or her patient to refer the individual to a reliable doctor in the new city; and apparently, many doctors from other states don't do this. Second, people taking stimulants don't usually have serious withdrawal problems, but coming off stimulants like Adderall can pose problems, because the person's brain has to adjust rapidly to the absence of the drug. The person who depends on Adderall will probably feel lethargic and "flat" when they don't have the medication on board. Students often panic, fearing they won't be able to study or put in the long hours required for academic performance.

As with other potentially risky medications (like Xanax, hydrocodone, oxycodone, etc.), the prescribing physician assumes certain risks and responsibilities in writing the prescription. I worry about this. Many patients tell me that they have only seen the doctor 3-4 times a year, and some say that they don't even see a doctor, because a mid-level practitioner (usually a nurse practitioner) writes the prescriptions under the "supervision" of a medical doctor. The typical "med check" or brief visit to renew a prescription lasts less than 20 minutes. This is not necessarily bad or wrong, but we certainly have to wonder whether the responsible doctor really knows very much about the patient. The Texas Medical Association has noted that authorities are cracking down on "pill mill" physicians in pain management clinics, and it's very likely that doctors prescribing other Schedule II ("dangerous") drugs will face similar scrutiny.
My expert opinion is that medications are very helpful in the treatment of attention deficit disorder. My further opinion is that many people, particularly students and younger adults, are using these medications inappropriately. This is one reason that I answer my own phone. I hate it when someone shows up expecting me to write controlled substances without any discussion. Yes, these are good medications that really help many people. And no, I won't write a Schedule II medication unless there's compelling clinical evidence that justifies the prescription.

Update 10/17/15: I have been reading commentaries by Larry Diller, M.D., a developmental pediatrician who has written extensively about stimulants. He has strong and generally well-informed opinions about the use and misuse of medications like Adderall, Vyvanse, Ritalin, and Concerta. His website and his opinions can be found here.