Is Adderall being overprescribed?
Adderall, the primary drug used to treat ADHD in the US, made an appearance on Bloomberg's Odd Lots podcast. A few pertinent observations based on that.
One of the podcasts that I listen to fairly regularly (and even appeared on as a guest) is Bloomberg’s Odd Lots. It is a weekly discussion on various things connected to financial markets, but not necessarily directly connected. There are discussions on supply chains. On sports. On teddy bears. On oil. On bond trading. And all that.
One of the most recent episodes is on Adderall, the drug of choice to treat ADHD in the US (but not elsewhere - it is not licensed in India or in the UK because it’s basically a mild form of MDMA (ecstasy) ).
I listened to this episode over the last couple of days and collected a bunch of pertinent observations that might be useful / interesting to readers of the blog.
ADD / ADHD basically became a thing with the publication of the DSM-III in 1980. What the podcast guest Danielle Carr claims is that lots of conditions which don’t really have much to do with each other got bunched into a few major conditions with this publication.
Basically the theory goes that just the process of labelling can create categories or groups, people who belong to which suddenly identify themselves with one another (there is one theory that some castes in India were formed this way, after the British conducted a caste census here some hundred years ago)Unrelated, DSM-V, which came out in 2022, makes matters worse by clubbing Aspergers with Autism.
I wasn’t aware of this - apparently recent studies have shown that SSRIs / SNRIs perform no better than placebos, on average, in terms of treating anxiety and depression. Having personally benefited (twice) from SNRIs, I don’t know what to think of this. This is what I had written about the need for antidepressants long ago
People seem to genuinely look at Adderall as a performance enhancing drug. The line “why shouldn’t I benefit from something that others can use to focus better” came up multiple times in the conversation. This, of course, assumes that Adderall is costless. I can’t speak about Adderall (not legal in India) but my experience with Ritalin is that while it helps focus better, it significantly dampens my creativity by cutting lateral and creative thinking.
So when I quit my job last year and decided to start my own company, I stopped taking Ritalin. When starting a company, creative thinking is far more important than attention to detailI remember, when I first took Ritalin (called Inspiral in India) in 2012, the doctor wrote out three sets of prescriptions. I had to present all three to the shop, of which two they kept and the third was stamped (“drugs issued”) and returned to me. There were only two pharmacies in Bangalore where I could get it (thankfully I didn’t live far away from those).
My experience post pandemic (2021-23) was rather different. Now, the number of copies had come down to two, and soon shops started accepting scanned PDFs of prescriptions. There was no physical copy now on which they could stamp “drugs issued”. So it was technically possible to get more drugs than you had been prescribed.
It appears (from the podcast) that something similar happened in the US. Adderall was a Schedule 2 drug (meaning pharmacists had to maintain records of who they had issued it to, and submit it to the government), but during the pandemic that got relaxed and people could prescribe it online. And this coincided with a sharp uptick in the number of prescriptions.
The related interesting thing they spoke about in the podcast is that a large part of the uptick in prescriptions for Adderall came from a handful of VC funded online psychiatry startups! They had taken advantage of the loophole of being able to prescribe Adderall online. The podcast alludes that the typical “growth hacking” you see in VC funded startups applied here, which led to a shortage in Adderall (there are licences and permits on how much can be manufactured each year) in the US
One thing that was discussed in the podcast was the increased prevalence of Adderall usage among coders in the US (possibly driven by VC-funded online psychiatry startups). Joe Weisenthal said it’s understandable given that coding is a boring job, and you need the dopamine hits while doing that, and that doesn’t come naturally.
My take is that coding is a job that requires extreme attention to detail (and it’s easy to make mistakes). The reason I needed Ritalin in my last job is that I was actively coding there, and mistakes were costly. So it may not be boring, but there are a lot of boring bits that you need to get right, which explains why a lot of coders might want Adderall (that said, coding also requires lateral thinking, when designing the algorithms. If you’re a coder on adderall, you should skip the drug on days you are writing logic).IMHO the ultimate losers of the discourse that ADHD medication is being overprescribed are people who genu`inely need the drugs. First of all, when you are neurodiverse, you aren’t able to make decisions. Now if you see the very basis of what is making your life so much better (the ADHD medication) being challenged, it cannot be a good thing for your mental health
In any case, the podcast came about after Danielle Carr had written this article on the overuse of Adderall. I’m yet to read it, but if you are of the persuasion that prefers to read rather than to listen, maybe you should read it.
In any case, you should listen to the Odd Lots episode on Adderall!