For most of my 20s, running out of Adderall was the problem that put everything else on hold. If my prescriber had forgotten or my insurance had done something arbitrary or I was going through a period of not having those things, nothing was more urgent. Without Adderall I had no other way to be a person, and it hadn’t yet occurred to me to look.
When headlines warning of a looming Adderall shortage started to appear late summer 2022, it was nice to experience them as more of a bystander rather than someone about to have an urgent problem. In October when I couldn’t fill my script, I felt pleasantly detached from the situation.
I didn’t need Adderall that badly at the time. If I did need to find it or buy it, there were still people I could call whom the shortage hadn’t reached quite yet. It wasn’t worth the time it’d take to cold-call pharmacies every day. For a while now I’d been using meth, and there definitely wasn’t a meth shortage.
So much dread, panic and constant worry used to go into maintaining my Adderall prescription. All the hours on hold and in waiting rooms for the privilege of being talked down to, choosing which days to function and which days to ration, for something that was never secure for more than a month at a time anyway, like trying to bail water out of a boat that was always leaking.
I’d assumed a high tolerance to one stimulant applies to stimulants across the board. That isn’t entirely true.
Regulated pharmaceutical meth is Desoxyn, which is FDA-approved for ADHD but not commonly prescribed. Methadone and buprenorphine are full and partial agonists, respectively, of the brain’s opioid receptors, but with stimulants the mechanisms involved are more varied and complex. Adderall is an indirect agonist of dopamine, as well as serotonin and norepinephrine, meaning it doesn’t bind directly to those receptors but does affect them. Meth is an indirect agonist too.
Adderall is FDA-approved at up to 40 mg/day for ADHD, and up to 60 mg/day for narcolepsy. I have neither as far as I know, but FDA indications aren’t, like, laws. Diagnoses for approved conditions aren’t the only way to convince insurance companies that something’s medically necessary, and over the years I got prescriptions written mainly for off-label treatment-resistant depression. If your prescriber will prescribe it, your insurance will cover it and a pharmacist will dispense it, then that’s all that matters, at least when not in times of drought such as now. These things line up easily for some people, and don’t for most.
I didn’t figure out I could rotate stimulants until I had access to meth and Adderall at the same time.
For the two years before I switched to meth, Adderall barriers had left me using mainly Vyvanse, another stimulant indirect agonist. Vyvanse works fantastically well for me after something like COVID or being institutionalized has compelled me to detox for a week, but works slightly better than nothing the rest of the time. Though it’s never really fit me, it is FDA-approved for binge-eating disorder and as such has been much more accessible.
There were times in that period when I had Adderall, too, but I didn’t really figure out the potential in having multiple stimulants until I had consistent access to meth at the same time as one or both of the prescription drugs.
Up until that point I’d kind of assumed that if your tolerance is high for one stimulant, then that applies to stimulants across the board. This isn’t entirely true. With access to multiple stimulants, you can rotate them, keeping your tolerance to one from climbing too high by shifting to the other for a bit. This has been the only genuinely useful stimulant harm reduction measure I’ve found to date (boofing of course, but that’s not stimulant-specific), and it’s extraordinarily inaccessible to just about everyone, whether or not there’s a shortage.
Multiple times, when I’ve painted myself into a corner with meth, I got myself out of it by switching to just Adderall for as long as I could—two weeks maybe, until I ran out or got into a bad place there, too—while the meth tolerance reset. I spent one winter using meth from morning through mid-afternoon, then swapping in Adderall for the rest of the day.
Finding the right balance was always a moving target that only stayed put for a few days, weeks or months at a time, but rotating stimulants—primarily Adderall and meth—has allowed me to function these past couple of years. Until around December or so, since when I’ve been increasingly overdue for a tolerance break, and—like everyone impacted by the shortage—have been having kind of a bad time.
Even before the shortage, rotating stimulants was something I could tell people about but not bridge them to.
The Adderall shortage, which is also shortage of Vyvanse and Ritalin, and likely all common ADHD meds by now, was first attributed to manufacturing delays at Teva Pharmaceuticals. Then to prescription demand increasing substantially during the pandemic, and the Drug Enforcement Administration’s production quotas for ADHD meds staying the same. Then to new pharmacy caps on all controlled substances resulting from a 2021 national opioid settlement.
Meth use has been climbing steeply the past couple of years, too. The shortage will contribute to that one way or another. For many people meth is cheaper, more accessible and less demeaning to acquire; it’s also often what’s in counterfeit pressed Adderall tablets.
After a decade of using stimulants, my list of stimulant harm reduction tips still pretty much starts and ends with the concept of rotating them, which even before the shortage was something I could tell people about but not really bridge them to. For many people who use meth, the barriers to prescription stimulants are a lot higher than the ones that were in the way of me being able to use Adderall effectively, which are now somehow in the way of being able to use meth effectively, too.
Feature art by Brooke Alexandria Paine