The other day, a patron named Ganymede send me a message that promptly shoved me down a rabbit hole: apparently, there are a lot of people on TikTok right now complaining that their Adderall (amphetamines that are primarily used as an effective treatment for attention deficit hyperactivity disorder) isn’t working for them and in fact may be FAKE, despite being obtained through a legit pharmacist with a prescription from a real doctor.
And let me tell you, my immediate gut reaction was “Oh, interesting, another social media-related mass hysteria a la the “tics” experienced by teenagers who were fans of influencers with Tourette’s.” Brain meds are tough to dial in for each person, and we’ve been in a particularly stressful period of time with the pandemic AND a national shortage of Adderall, so I figured that someone got skeptical and made a TikTok about how they don’t think their meds are working any more, someone suggested that maybe it’s because there’s no Adderall in their Adderall, more people piled on and started wondering if THEIR drugs were really working, and then it all snowballs into a big stupid conspiracy theory.
But! It’s actually a little more complicated than that. As always.
So, first of all, the New York Times has already covered all the stuff I originally suspected, but I’ll go through them briefly because reading is hard AND there’s a paywall AND there’s something they miss. But, yes, due to the shortage, some people may have their prescriptions adjusted: name brand to generic shouldn’t show a difference but maybe some people are susceptible to it, there are definitely differences between Adderall and other stimulants used to treat ADHD, and there are differences between different types of time-released medications, like extended-release versus short-term Adderall. All of these could cause someone to react in a different way to those different meds compared to what they were prescribed previously.
And yes, the pandemic and the Adderall shortage could cause people to be under a lot more stress, which could make them think that the drugs aren’t working. It could also lead to them stopping and restarting the drugs, which could cause new symptoms.
And yes, cognitive bias comes into play: if you see a bunch of other people saying their Adderall is no longer working, you might start to wonder if YOUR Adderall is still working. You thought it was, but now you’re not so sure! Did you always feel this jittery? Are you more distracted? Less motivated? Hmm!
All of that could, of course, lead to a sort of mass sociogenic (or psychogenic) illness, which we previously called “mass hysteria.”
But then I watched one of the TikToks that my patron sent me as an example, and I was surprised to realize that none of those explanations fully explains what’s going on with her.
Okay, if you are just reading the transcript, let me describe what happened: this woman with ADHD was unable to get her Adderall for many months, until she got on better insurance and finally got a new prescription from her doctor. Patients on Adderall (Americans, at least) are forced to take a drug test on a semi-regular basis to prove they’re actually taking their meds and not selling them to rich charter school kids trying to pass their midterms. Yeah, we live in a dystopia, what about it?
Anyway, she took the test and it came back negative for amphetamines. And in a follow-up video, she took another test and it ALSO came back negative. She is now melting down, which is understandable, because this might mean she can’t get her prescription renewed, but also what the fuck? She says she has two pills left and is willing to get them tested to see if they are actually Adderall but at the moment she doesn’t know where to turn.
That New York Times piece stated, ““To date, the F.D.A. has not identified safety or quality issues with Adderall products, or signals indicating a loss or change in efficacy,” a representative for the F.D.A. said in a statement. A representative from Teva Pharmaceuticals, one of the largest manufacturers of Adderall, wrote in a statement that “all Teva manufacturing processes and practices are the same (and we continue to distribute the same brand and generic Adderall products).””
So this leaves us with a few options. Either:
- This woman is lying, and she photoshopped her test results
- A pharmacy or pharmaceutical company is about to get sued all to hell
- Both tests ordered by her physician are faulty
Let’s go through them: first, people lie on the internet ALL THE TIME for reasons only they can guess–for money, for “clout,” for attention, just because. That said, I don’t think this woman is lying. Could she be? Sure. I’m pretty much always right about everything but hey, stranger things have happened.
And yeah, it’s a possibility that some screw-up happened here, either at the pharmacy or at the pill factory. I mean the actual factory where the pills are made, not the metaphorical “pill factory.” That said, these are controlled substances – amphetamines of any kind aren’t even legal to possess in some developed countries, and here in the US Adderall is a highly regulated Schedule II drug. This isn’t like homeopathic pills, where you think you’re taking essence of wildflowers but it’s really, like, botulism or something because no one knows or cares how the pills are made.
Ironically, it’s exactly that high level of regulation that makes it a possibility that a pharmacist is to blame. Allow me to explain: Vox reported last month that the Adderall shortage, which began back in October of 2021, isn’t just another “supply chain” issue we can blame on the pandemic. It turns out that while demand for Adderall has been steadily increasing over the years as doctors get better at diagnosing ADHD and the evidence mounts that amphetamines are a hugely successful treatment, the US Drug Enforcement Agency has continued to crack down on the distribution of these stimulants at nearly every level:
“To mitigate the potential for abuse, the Drug Enforcement Administration sets production limits for Adderall and its generic competitors. In order to produce the drugs legally, pharmaceutical manufacturers must obtain approval from the government and comply with regulations for the medication’s manufacturing, distribution, and dispensing.
“But another factor, new limits on the dispensing of the drug at US pharmacies, is making the situation worse.
“In 2022, drug distributors reached a settlement with most states over their role in the proliferation of prescription opioids that helped create an addiction and overdose epidemic. Bloomberg reported this week that, as part of that settlement, secret limits were placed on the dispensation of controlled substances last July. That has in turn prevented pharmacists from filling the prescription of every patient who comes to their pharmacy with an Adderall order.
“According to Bloomberg, in essence, manufacturers are supposed to limit a pharmacy’s supply of drugs covered by the Controlled Substances Act, which includes opioids as well as stimulants. Pharmacists can only fill a certain number of prescriptions over a set period. But there has been widespread confusion over these rules because the pharmacists themselves don’t know what the limits are or when they are approaching them. Sometimes, they won’t know their access to Adderall has been cut off until trying to fill a prescription.
“In theory, that information is hidden to prevent anyone from gaming the system. But in practice, it has made it harder for patients to get access to the medicines they need during a six-month shortage.”
A medicine that allows millions of people to live normal lives is being treated first and foremost as a dangerous narcotic to be abused, which is why we assume patients are criminals and force them to prove otherwise with regular drug tests. We’ve forced desperate people into desperate situations, and when we do that, what do we see? An increase in crime, like, say, a pharmacy tech swapping out pills to sell later? Sure, maybe.
But what about that third option: two tests in a row showed false negatives? One test, sure, but two? That’s a pretty serious fuck up, right?
But it turns out that Adderall patients have been complaining about this for YEARS, even before the shortage began. Check out this forum post from four years ago from a woman who writes
“I’ve been treated for ADD for at least the past 10 years and prescribed Adderall ( currently taking the generic version by Prasco). I take 25 mg of Adderall XR and 10mg of immediate release mid day. I take my meds religiously. My new doctor gave me two urine test to screen for Amphetamines and BOTH came up negative. He’s said he won’t prescribe my meds any longer. I am beside myself. He is clearly insinuating that i am doing something other than taking my medication myself. I’m a 47 yr old working mom, never took or take drugs and have never encountered anything like this. What could possible be causing a negative result when I take my medication every day??”
And in the comments are dozens of people who experienced the EXACT SAME THING: urine tests coming back negative despite the fact that they took their meds. What gives?
Well, a few of those commenters offered the solution: blood tests. Comment after comment, people say they had multiple negative urine tests before getting a positive blood test. Why? Urine seems like the best way to test for amphetamines, because it should appear there for 72 to 96 hours after last use. It will only stay in your blood for up to 46 hours. However, people metabolize drugs at different rates and blood tests consistently show amphetamines more quickly after you last took them. So let’s say you hadn’t taken any Adderall for two days, and let’s say that you also metabolize it very quickly. You take another pill just before you take your urine test, as the woman in the TikTok video says she did. Your previous pill has cleared from your system and your latest pill has yet to reach your urine, so the test is negative. In the same time period, the pill would have made it into your blood and thus would have been detected with a blood test.
The sad thing is that there are several comments in that previous forum thread from people who say they asked for a blood test and were denied. Blood tests are more expensive than urine tests, AND we treat patients in need as criminals, AND we live in a time when capitalism has made our healthcare system a dystopian nightmare.
Earlier I said, “We’ve forced desperate people into desperate situations, and when we do that, what do we see?” We see an increase in crime, yes, but we also see an increase in superstition and magical thinking and conspiratorial thinking. In an ideal world, this woman never would have gone off her meds due to lack of good health insurance and then she never would have needed to take a test to prove she wasn’t a drug dealer. In a slightly less ideal world, but still better than this world, her doctor would know that a blood test may be more accurate and order one at no cost to her. She’d then sit down and make sure that the medicine is doing what it’s supposed to be doing, and tweak the prescription if necessary.
In THIS world, the patient goes without her medicine for six months due to lack of decent insurance, then finally gets her prescription filled because she got a better job, then gets a false negative urine test that causes her healthcare provider to question her need for medicine, then has a social media meltdown where she assumes that her medicine isn’t even real, and then this.
That’s right: the medical establishment abandoned her, and who was there to pick her up? Snake oil salesmen, who got $118 out of her pocket. Great job, everyone.