I have been prescribed Adderall for over five years. I was diagnosed with ADHD just after I started college and was having a tough time in my classes. I saw a psychiatrist, spoke to them about my issues concentrating in school, did a few questionnaires and was prescribed 10 mg Adderall twice a day. I received my prescription without issues, but was subjected to random drug testing for amphetamines to determine whether or not I was actually taking the drug.
Adderall was a game-changer for me. I was able to focus during lectures and concentrate enough outside of school to complete assignments. As a result, my grades skyrocketed. I continued to use Adderall as needed, mostly for school and work, as recommended by my psychiatrist.
Then came a short period where I was in between jobs, struggling to find work, and no longer had health insurance. Paying out-of-pocket for all the medical expenses related to continuing my Adderall prescription, even if it was generic, was prohibitively expensive for me.
Given my interest in neuroscience, I read some of the work of Dr. Carl Hart, who has pointed out that “methamphetamine and Adderall are essentially the same drug.” I became more interested in methamphetamine and found that it is used for treating conditions including obesity, narcolepsy and ADHD.
In need of the benefits Adderall had provided but unable to afford a prescription, I decided to acquire a gram of methamphetamine.
Luckily, I had a buddy who would sell substances they bought through the dark web, and I asked them to get me some meth. I purchased the gram for $50. As soon as I had it in my hand, I pulled out my DanceSafe reagent testing kit. I came to the conclusion that what I had was presumptively methamphetamine.
I expected it to be a whole different ball game. In fact, it was extremely similar.
I started with a 5 mg dose—a threshold dose I found advised at places like Erowid and Drugs.com. I opted to take it orally that first time, as I read that this would have longer-lasting but less intense effects compared with other routes of administration, such as smoking, injecting or rectal administration.
Despite all I had read about methamphetamine prior to using it, the stigma associated with the drug was ingrained in me, and I expected it to be a whole different ball game. In fact, it was extremely similar to Adderall.
One difference was the duration of the effects; I would compare a 5 mg dose of methamphetamine to one 5-10 mg dose of Adderall, followed by another in four hours’ time. Another difference I appreciated was that I did not feel some of the peripheral effects I would get with Adderall, such as restlessness, anxiety or overstimulation.
As I experimented further with that gram of methamphetamine, using different dosages and modes of ingestion, I continued to find practically identical experiences to Adderall; a longer duration and more pronounced euphoric feelings in higher meth dosages were the main differences. Methamphetamine is a useful drug, but I also value Adderall for its legality, slightly less “fun” effects, as I found them, and its relatively short duration.
I used that gram until it was gone, but after that I didn’t feel like I needed stimulants, other than caffeine, to get by.
Some months later, I was back in school and wanted to get my Adderall prescription again. I was in another state, now also working for a place that provided insurance through Kaiser. So I made an appointment to see a doctor, requesting my medical information from my previous psychiatrist.
At the appointment, I had my blood drawn and was provided the Adderall prescription. I used it on and off, depending on my workload, for over two years. To avoid developing tolerance, I decided to skip some days and keep my dose relatively low.
Then one time, I filled my prescription online through Kaiser a month before the start of my upcoming semester. I figured this would leave ample time to get my medication. When I went to pick it up, the pharmacist said I had to see a doctor to write the prescription again.
It turned out the doctor was against prescribing me Adderall if I was using cannabis—a legal drug where I live.
I scheduled an appointment with the first doctor I could see. When I spoke with her, the first thing she mentioned was having to drug test me to provide the Adderall prescription. I figured this would be the same as the previous urine screening I’d had. But when I asked if they tested for cannabis, it turned out the doctor was against prescribing me Adderall if I was using cannabis—a legal drug in the state where I live.
I told the doctor I had used Adderall for years, and that my cannabis use had never caused issues in my life or stopped me from getting my prescription. I then asked if this no-cannabis-with-Adderall policy was dependent on her discretion. Avoiding the question, she just reiterated that this was the policy.
After more back-and-forth with this doctor, I realized I was getting nowhere, and refused to take a drug test that I knew would find positive for cannabis.
Instead, I booked an appointment with my new primary care provider, hoping they might give me leeway considering the productive life I was leading—working, going to school, volunteering and freelance writing.
While waiting for that appointment, I read the DEA Practitioner’s Manual, which outlines the Controlled Substances Act (CSA) for prescribers of scheduled drugs. The manual states: “With respect to pharmaceutical controlled substances, DEA’s statutory responsibility is twofold: to prevent diversion and abuse of these drugs while ensuring an adequate and uninterrupted supply is available to meet the country’s legitimate medical, scientific, and research needs.” Adderall is classified as a Schedule II substance, deemed to have “high potential for abuse.” The manual also states that the prescribing practitioner must conclude that providing the patient with the drug does not create an undue risk of diversion or “abuse.”
It seemed the first doctor, mindful of protecting her medical license, was unwilling to prescribe Adderall prescription on the basis that I might be “abusing” cannabis; but there had been no thoughtful conversation about this possibility.
By now, I really needed amphetamines to keep up with my workload. I decided to use methamphetamine again to treat my ADHD because it was basically all I could get. Once again, I was fine. But even for those of us who check our drugs, an unregulated substance always poses more risks than a pharmaceutical equivalent.
I came across a research paper prepared by Kaiser which states, “there is no evidence on the benefits or harms of screening versus no screening for drug use” when prescribing controlled substances. Yet screenings are still used to deny prescriptions to people who need them, creating harms.
There are plenty of benefits to screening for companies like Kaiser, however: Urine drug testing is a highly lucrative business.
His reaction was that “functional addicts” can do really well for a while, but will ultimately succumb to their “substance abuse.”
When I finally got to see my new primary care practitioner, I repeated my story. His reaction was to mention that “functional addicts” can do really well for a while, but will ultimately succumb to their “substance abuse.”
I found this offensive. This was the first time I met with him and he was already suspecting that I was an “addict,” due to my use of cannabis, without having any further discussion with me.
I asked him if he would deny me an Adderall prescription on the basis of an equivalent level of alcohol use. He said no. I found this outrageous, but still wanted to find a way to get my prescription.
He did at least validate my concerns that denying the prescription might do more harm than granting it. But he said I would have to do a urine screening, then he would follow up with the Kaiser psychiatrist. I reluctantly agreed to the screening and was on my way.
I continued to use methamphetamine to treat my ADHD. A few days later, I got an email stating “The results of the urine screening were as expected. My plan is to have you abstain from cannabis next month with the goal of demonstration that you can abstain from cannabis in that timeframe”.
Basically, I would need to provide a “clean” urine sample in order to get my prescription.
I promptly called a friend of mine who doesn’t use cannabis and asked them for a sample of their urine.
Luckily, this doctor was somewhat reasonable and agreed on my next visit to prescribe me Adderall for one initial month. I thanked him for his consideration and said I would adhere to his instructions. I haven’t used cannabis since.
But I promptly called a friend of mine who doesn’t use cannabis and asked them for a sample of their urine. I stored it in the fridge, and plan to provide it for my upcoming urine drug screening.
I am not going to permanently stop my non-problematic use of a legal substance to receive the prescription that I need, just to obey draconian drug laws and support healthcare industry profits.
I wasn’t forced to stop using cannabis because it might be harmful to my health or interact negatively with my prescription. I was forced to stop because it is federally illegal and I was a source of profit for Kaiser. If my doctor really cared about the cannabis use negatively interacting with Adderall, as he told me, he would have treated my alcohol use with exactly the same scrutiny.
Many Adderall patients are forced to find ways to cheat the system as I am doing. Unfortunately, not everyone has access to reliable sources of methamphetamine or the ability to fake a drug screening. For now, I will continue to pay Kaiser hundreds of dollars every month while I wait for open enrollment to enable me to get out.
Photo by Patrick Mallahan III via Wikimedia Commons/Creative Commons 3.0.