Short acting vs long acting stimulants

[MindResearcher]

I must post this for some views on this. A friend of mine went to his P doc to day, and I ended up getting into an argument with him, via his pdocs doings. He was perscribed adderall xr for like 3 or 4 months now, and doesnt help. I notice this in his actions, even esp when we go say to a store, he wants to leave in 10 min all the time, as apposed to me llike Ill stay 1 hr.

He went to his doc, and kindly advised him of the truth and that he does not respond to xr, and has been on ritalin and metadate without much releif. Dexedrine spanuals is the only long acting one he hasnt tried. Or concerta but thats still methylphenadate.

Now, my point is this. His doc totally treated him like he was "going to abuse them , meaning the IR versions, because He asked to try regular adderall. NOw his doctor responded " No way do I perscribe Short acting stimulants to addicts (opiates) , which basically the same problem with oxys I did, but said ill perscribe you Concerta or Ritalin SR. Im sure spanuals also. Now there are a few problems I would argue.

I do agree with a doctor if a person is an addict, that a carefull observation and medication regiment is given but He already has perscribed him RItalin and adderall Xr. He was never into cocaine or speed, but ok, most doctors may not care. But then, Hes not responding to long acting meds, JUST as I also failed to, Unless I maybe took 1/2 of say adderall 30mg IR with 20mg of XR. Plus his doctor knows hes not abusing the xr's becasue hes never early or calling him for another refill, and such. He came off like well " an addict will definately abuse IR versioins but moresoe not abuse XRS.

Im sure the doctor heard of people taking the capsules apart and crushing the beads and snorting away, much easier than the regular adderal, or even chewing up the XR's

But one comment I must say, That there was a pretty big difference between IR and XR version of adderall with me. I actually notices at least a decline of 50 percent effectiveness in Xrs, but I know people who like them alot. Now my doctor,, really had no problem perscribing me IR adderall, and he is an addiction specialist MD, certified in perscribing Suboxone. SO, He would have gave me Xr versions off the bat. I then tried Dexedrine spanuals and thought I was going to benifit , but I felt I could have taken 3.

Well, My last comment is, IF a doctor is going to work with someone, and help them, he should try different things. I ran into this many many times and I always suffered , using, drinking, bad moods, because the doctor didnt want to put time into it and maybe consider other options. But Once he or she found out I abused opiates and alcohol, well I guess I will abuse every drug. I see his point , but now there is a kid who may turn to using again or at least remain in his same mental state, when Adderall IR's (and my friend has tried the IR version and liked them alot , moresoe responding better, which I noticed a huge improvement) .
just my opinon gm

[badders]

imho: get a different doctor.

it is ok for a doctor to disagree with the patient, but calling him an addict is a bit unprofessional.

[T-Bass]

WE ARE ALL ADDICTS! one way or another

[livinginchaos]

I agree with Badders! Your friend needs a new doc. Is this doc an ADD specialist? or at least keeps up on all the ADD info?

If not, that's exactly why I do not go to a doc who doesn't specialize in ADD, or at least keeps up with all the ADD info and reading up on the meds. I don't know stats, but I think the numbers of people who become addicted to ADD meds (without a history of addiction) are very low.

[HIXX]

Uhhh...I think you guys are missing the crucial part of his post

"No way do I perscribe Short acting stimulants to addicts (opiates)"

His buddy is already an addict(or recovering addict). In this case I believe the doc might be on the right track. Obviously stimulants haven't been working for the kid so why get down on the Doc for removing the temptation that could result from IR and attempting to prescribe a non abused medication?

[Imnapl]

MindResearcher also wasn't actually with his friend at the doctor's appointment and received the information second hand, right?

[livinginchaos]

Sorry, MindResearcher -
I lost the point of what you were saying because I mis-interpreted what you wrote about the addict part.

[Hyperion]

Opiates and amphetamines are very different drugs. That a person was addicted to one does not imply that they will become addicted to the other, although it is certainly possible that people with addictive personalities may become addicted to any habit-forming substance.

I'm surprised at the doctor's IR vs. XR stance, though. I would have thought that he'd feel better about prescribing IR drugs, where there's a smaller dosage per pill, than the XR form, which usually has more per pill.

You mention that your friend has tried ritalin. Was it instant release or sustained release? If instant release, did it work better than the extended release stuff he's taking? If he hasn't tried it in instant release, would his doctor prescribe that?

Doctors refusing to prescribe medication because of prejudices regarding their patients really bothers me. The first psychiatrist I saw after my psychologist diagnosed me with AD/HD was one who worked for our college, and she was so concerned about abuse ("I'm always suspicious of people who are diagnosed at your age" I don't know how I saved myself from punching her) that she prescribed me Wellbutrin, which almost killed me. Denial of treatment is a violation of the hippocratic oath and should result in the revocation of their license, but that would presuppose that the drug policies in this country were even remotely connected to reality, a notion which even a cursory read of the Controlled Substances Act will disabuse.

[Gregster]

I think the problem here is not the doctor - he/she is being prudent.
Some people complain about XR type preparations because the release is uneven, doesn't last long enough, lasts too long, etc, and those are valid reasons to want to switch, but "XR doesn't work at al, I want to try immediate release" makes no sense. The drug is being delivered in both cases, and the drug is the same, so if amphetamine or methylphenidate works, it works, XR isn't going to change that. A claim that an extended release doesn't work at all is going to raise red flags with any doctor, and from someone who has previously abused prescription medication, it's hard not to think that it's happening again - it's relevant to note that he would have had to lie to the doctor to get the opiates, and doctors can get into trouble if they are found to have supplied drugs to an addict and didn't take precautions to avoid abuse.
I'm simpathetic to those with substance abuse issues - we are only human and thrill seaking and poor impulse control define the adictive personality - and ADHD, but it's not unreasonable to have to earn the doctor's trust, given the cirumstances. This falls firmly into the "fool me once, shame on you, fool me twice, shame on me" category, and doctors don't like to be made fools of. I'm surprised his request didn't produce an instant medication change to Strattera!

[rgcpro]

sorry for bringing up this old post, but i'm rather new here so i was reading through some of the older posts in an attempt to catch up to the rest of you.
The comment you made, Gregster, about the IR and SR/XR forms of pills not differing in their effectiveness is something i can contradict. I actually posted in the Ritalin forum about how i was originally prescribed the IR form of Ritalin which worked wonderfully but didn't last long enough. Unfortunatly i had to move away for the summer from the Dr who originally diagnosed me (he's a specialist in the field) I was uncomfortable continuing to find the "right" med for me. I was under the same impression as you, methylphenidate is methylphenidate. So while i didn't want to have my family doc prescribe me a new kind of medication i asked if he'd give me a script for ritalin SR to try. Man was it ever an awful experience. And this is coming from someone who responded VERY well to the IR form. The delivry system can indeed cause the med to fail completely for some people, i'm proof of that.

here's a link to my post in the ritalin forum
http://www.addforums.com/forums/showthread.php?t=20360