A thing they don’t tell you when you start amphetamine for ADHD, but they SHOULD, is that what they do is NOT make you function like a neurotypical.

What they actually do is turn you into a person with ADHD with greater capacity.

Sometimes MUCH greater capacity.

And there can be a honeymoon phase when you’re all like, “OMG! I’m saved! I can do all the things now!”

And the risk is that you will use the extra capacity to mask harder and engage in more of the same stuff that was causing burnout.

And then 3-6 months later you find yourself in the same place you started but with an amphetamine habit. Also you can sit still.

I see a LOT of people online who hit the point a few months in where they conclude they have stopped working and start desperately doing meds breaks, long supplement recipes, etc to get back the “functionality”.

And these people, more often than not, also seem to have massive internalised ableism. They never accept their own disability, instead thinking it’s their “duty” to use any means possible to “not inflict my shame on anyone else”.

And using up that extra capacity from amphetamine to do that is a nasty trap because you can’t go back. Ever.

You HAVE to accept what you are.

@goatsarah Using speed to treat ADHD always seemed a bit of a grift and prescribers are usually FAR too lazy (or overstressed/worked) to figure out HOW to use the drug. Here. Prescribed. Take. Daily. Bye!

Wrong. How to use it episodically while limiting the addiction risk (but NOT eliminating it) MIGHT find a better use for the drug but that is also difficult for the person using to navigate.

There's gotta be better than this shit. (And should be accompanied by ENDING the bullshit "war on drugs" so we can use the funds to FULLY fund health care).

Sorry, gotta bomb Iran.

@FIAR_Light @goatsarah Ah yes, those extremely addictive drugs that I keep forgetting to take...

@neoluddite @goatsarah Hmm....speed CAN be addictive--but again, I'm saying we need better treatments or alternatives for those who find it problematic. That does NOT mean I think it should be eliminated as an option but AS an option, more exploration in how best to use it. Sounds to me like you use it more when you need it and then other days, forget to. Some will need it daily; others not but the standard is just to take it every day.

So I'm saying we need more study and effort around NEW treatments as well as studies on how it is used.

I am not against drugs of any kind. Indeed, I find low doses of psychedelics extremely effective. A 'mezzo' dose every few weeks is what works for me.

@FIAR_Light @goatsarah I need it every day because I have ADHD, but I forget to take it, also because I have ADHD

@FIAR_Light @neoluddite Non stimulants exist. Speed is the first line drug for a reason; it bloody works.

Leave us and our speed alone in peace, which we get by taking speed.

@goatsarah @neoluddite Please don't feel that I'm threatening that or suggesting you or anyone NOT use it! My apologies to you if that came across.

It works for you and for many, indeed. I am not arguing that. But it does NOT work for everyone and so we need better alternatives and/or perhaps better WAYS of using it studied.

At the same time, I am sorry if my commentary began to sound like I'm stigmatizing anyone for using it! Carry on and be well!

@FIAR_Light @neoluddite this seems like a weird hill to die on.

It is known to work for 80-90% of the people it treats, which is a proportion many medications can never hope to reach, and with more efficacy than any other psychiatric medicine.

And a lot of the remainder it works for with less efficacy, and a smaller number of them don’t actually have ADHD and are misdiagnosed by a clinician who thinks it’s “phone scrolling disease”.

I mean, it’s up there with ibuprofen and paracetamol for efficacy.

Why THIS medicine in particular, when we are already stigmatised for taking it by many?

@goatsarah @neoluddite A hill to die on? No, but as a gay man, I've seen what speed can do to people. On the upside, with doctor's care, if comprehensive, can minimize risks/adverse events and recognize drug-drug interactions. Lots of those:
https://www.mayoclinic.org/drugs-supplements/dextroamphetamine-and-amphetamine-oral-route/description/drg-20071758

As to efficacy--I'm not super aware of that literature but these two meta-analyses suggest it's not as effective as you suggest? Which is why I asked for studies to support your statements? See, e.g.,
https://pubmed.ncbi.nlm.nih.gov/33085721/
and
https://pubmed.ncbi.nlm.nih.gov/30091808/

As to stigma, as I said, I am NOT into that. Mine is a harm reduction perspective. As you allude, misdiagnosis and over-prescribing bring the same "cultural" risks as with opiates--it opens the door to stigmatizing people as it increases risk of harm.

Opiates are a good comparison (also "Scheduled" drugs). Let alone what the Sacklers did with their greed and the subsequent stupid swing from JUST SUFFER to have a twinge? Eat opiates! This renders smart use of opiates problematic.

That all said, I agree with you the drug IS effective--I'm calling for pushing for more research for better/safer drugs. In the meantime, I support people's use of and access to speed, along with ongoing monitoring to assure efficacy isn't waning.

Dextroamphetamine and amphetamine (oral route) - Side effects & dosage

Mayo Clinic

@goatsarah @neoluddite There's also this non-stim drug that has fewer adverse events and similar efficacy, centanafadine. Though it's early days and non-industry studies will be needed.

i notice they did NOT have an amphetamine/dextroamphetamine comparator arm:
https://pubmed.ncbi.nlm.nih.gov/39132746/

General info:
https://www.additudemag.com/centanafadine-drug-for-adhd-ndsri-norepinephrine/

A matching-adjusted indirect comparison of centanafadine versus lisdexamfetamine, methylphenidate and atomoxetine in adults with attention-deficit/hyperactivity disorder: long-term safety and efficacy - PubMed

<span><b>Aim:</b> To compare long-term safety and efficacy outcomes of centanafadine versus lisdexamfetamine dimesylate (lisdexamfetamine), methylphenidate hydrochloride (methylphenidate) and atomoxetine hydrochloride (atomoxetine), respectively, in adults with attention-deficit/hyperactivity disorder (AD</span> …

PubMed

@FIAR_Light @neoluddite and I am not taking fucking reputake inhibitors. Bullshit zombie drugs that they are.

“Sit in the corner and try to scream but you can’t, because you are dead inside. At least you aren’t bothering anyone.”

Fuck that bullshit.

@FIAR_Light @neoluddite Look. I’m going to say this once.

Fuck off and take your ableist bullshit about the medication that saved my life with you.

@goatsarah @neoluddite I didn't say anything about what YOU should do. You're not the only person living with ADHD. Good-bye.

@neoluddite @FIAR_Light “I’ve seen what speed can do”

Yeah. Me too. In particular: House is clean. Blood pressure has gone from grade one hypertensive to low normal. Sleep quality has improved. Alcohol consumption dropped from 30 units a week to ZERO. Diet now includes salad. Weight gone from obese to ideal. Getting more exercise. I no longer hate myself. My tics have stopped. I can hear what people are saying in noisy environments. My driving has improved. THE FUCKING BED IS MADE.