Dilemma with refilling/changing my ADHD meds - need advice (ideally from a psychiatrist, or anyone with insight)

[transpersonal_psyche]

Hey guys,

TLDR/Main Question - my current psychiatrist is titrating my medication too slowly, and its beginning to negatively effect my life. That said, according to my pharmacy, I have 1 refill remaining of my previous formulation of ADHD medication prescribed by my former psychiatrist. I was on this formulation for at least 3 years, perhaps 4. On the app, my refills are divided into "Refillable with a doctors call" and simply "Refillable." The refill for my previous doctors script is listed under the "Refillable" category. I am tempted to request the refill, as it expires next month,

That said, I am concerned that doing so will alert my current psychiatrist, and will be interpreted as an attempt to get additional medication to either sell and/or abuse. This couldn't be farther from the truth, but will be interpreted as such, because I've experienced kratom addiction (which started the last time I lost access to my meds in a desperate attempt at self-medication to finish school).

As an aspiring academic and someone with rather severe ADHD, I need proper access to medication. I live in Colorado. What would happen if I requested the refill? What if I left my current psychiatrist and then requested the refill (of course I'd seek a new psychiatrist in that case)?

I'd like to get back on my original formulation, or at least Dexedrine ER with the option of an IR booster. Perhaps I should cancel my next psychiatry appointment, find a new doctor before my OG script expires, and ask to be put back on that formulation (at a lower dosage, obviously)? Trying to fill it beforehand would likely look bad. I am also concerned that my involuntary commitment nightmare related to my kratom issues will be directly accessed by any psychiatrist I see.

Any advice would be profoundly appreciated. Thanks!

- Full Story -

I was diagnosed with adult ADHD-PI (although I displayed behavioral/hyperactive issues during early childhood) nearly a decade ago, shortly after starting college. It took awhile to find the right medication for me, but eventually we settled on Dexedrine. I experience duration issues, especially with Vyvanse and Focalin, so I was on an instant release formulation (3 doses per day). I also have OCD, which has been successfully managed by treating my ADHD. Moreover, according to several tests (including one from my former psychiatrist), I have Asperger's syndrome (or "high functioning autism" to adopt contemporary nomenclature)

Due to tragic circumstances beyond my control, my pediatrician died quite suddenly from cancer during my last semester. I was faced with either dropping out of my classes (because I had to get reevaluated by another psychiatrist before I could regain access to my meds, a 2 month process) after the deadline (which would have thrown my 4.0 GPA down the toilet with five F's on my record), or resort to alternative treatment. Foolishly, I resorted to using kratom to get me through the rest of the semester, a psychoactive I had used responsibly for over a decade (before I was diagnosed; in retrospect, when I used kratom on the weekends, I used it to help me focus without fully realizing it).

I knew it was physically addictive, but I prioritized my GPA over my mental health. I thought I'd easily be able to quit after graduating, but several other traumatic events occurred that made it impossible for me to detox on my own. By the time I finally got access to my meds, I was taking kratom daily just to feel normal. Due to its low effect ceiling, the positive effects of kratom rapidly dissipated within a few months. I was too ashamed to tell my psychiatrist at the time, and also afraid that I'd lose access to my medication, which is necessary for me to function normally. Without my meds, I will go weeks without even brushing my teeth,

I sought help, but unfortunately I was thrown into a cruel detox center for the homeless (mind you, I'm middle-class with majors in both psychology and philosophy, but also dead broke and rely on Medicaid) and was involuntarily committed for 9 months - longer than men who were injecting alcohol, entering meth psychosis, and almost every other extremely severe case of addiction. I had to spend 5 months living with some violent criminals who just got out of prison. Many of the people employed to watch us were hardened, seemingly reformed criminals with no clinical training whatsoever. I am lucky I made it out unscathed; I was fortunate enough to accrue a few friends who kept me saved. I was placed in an environment filled with violent criminals and "counselors" who were less qualified than I was to conduct therapy (maybe I'm bragging a little, but it was undeniably true). I've been studying and self-facilitating transpersonal and depth psychology for over 15 years, and half as long studying philosophy. The environment was ideologically oppressive. I had to censor myself constantly under threat of extending my involuntary commitment.

I was there for the relatively benign kratom; everyone else were severe alcoholics, meth addicts, fentanyl addicts, etcetera. During that time, I had to switch psychiatrists. Of course, I had to tell him about my experience getting off kratom. First, he forced me to try Strattera and Wellbutrin, which did not work. After 4 months of side effects with minimal benefits, he finally started me back on Dexedrine ER on almost the lowest possible dosage (10mg, so 5mg twice a day). He titrated me every two months, by 5mg (so in IR terms, from 5mg to 7.5mg). Keep in mind, I've been on this medication for almost a decade, and my original dosage began at 10mg twice a day, which slowly titrated to 20mg x3 a day. So you can imagine my frustration, waiting months to get back into a functional state. I'm trying to prepare for graduate school to study transpersonal psychology, which has required immense amounts of reading, reflecting, writing, and meditating.

It took months for me to finally get on the standard 20mg Dexedrine ER. As an aspiring academic, extensive reading is a prerequisite for success in my field. Without proper medication, I can't read for more than 5 minutes at a time, that is, if I remember or feel motivated to read at all. For a while. the 20mg ER worked (4 months), and I've been rigorously preparing for graduate school. That said, my dosage is about 10mg less than it should be at this point psychiatrist is simply not titrating me correctly. Ever since the opioid crisis, psychiatry has conflated opiates with every other medication with addiction potential, and it's absolutely screwing people like me who genuinely need those medications. It's absurd to begin with that dextroamphetamine is Schedule II while significantly more addictive psychotropics like diazepam are Schedule IV. And don't even get me started on the legal inconsistencies involving psychedelics. You all know.

He won't even look at my medication history because it would "take too much time"! I have an enormous amount of responsibilities. The friends I made need real therapy, and I've had to use my 15 years of personal experience to attempt to help them. Training, but not really, because my friends (and "patients") have been through severe trauma. Fate gave me a internship, which I'm burdened by but have begrudgingly accepted. But this requires an absurd amount of time and energy, and I've got to pursue my studies on top of that. Due to duration issues, I should ideally have a booster dose for some evenings. But my psychiatrist won't listen, largely because of my struggles with kratom. What he fails to understand is that my medication actually keeps me from doing something stupid and resorting to less effective self-medication. There has been evidence provided in the literature supporting this, but I guess a lot psychiatrists don't keep up, or are afraid to.

I am well-educated, both formally and self-taught, with a long but largely casual interest in psychopharmacology. My experiences with therapists and psychiatrists over this past year have been profoundly frustrating. It should not be the case that someone like me, with a casual interest in pharmacology, can describe the pharmacodynamics of medications more clearly than the professionals I have met with. Not even to mention the decrepit "therapy" I had to suffer as a ward of the state. I was a fish out of water. The state of our addiction treatment institutions in Colorado, at least for the lower-class people dependent on Medicaid, is borderline tortuous. I spent an entire month in a detox center that didn't even allow music (no electronics), kept the lights on 24/7, consisted of a single large room packed with 50+ people, and was monitored by "counselors" that would be better categorized as "desensitized pricks" (save for 1/4, but I wasn't lucky enough to land with them). Several friends I made during my stay, who've spent time in jail, have told me that the conditions in the detox center were worse.

 

[arrall]

Thank you for sharing your story.
It was really heartbreaking to read what you're going through.

As for your question, I don't know how prescription notifications work in the US so I can't advise you on whether or not to do that.
But if your psychiatrist refuses to even look at your medical history and is titrating you ridiculously slowly, you might want to look into a new psychiatrist.

 

[spammie nurse]

" But if your psychiatrist refuses to even look at your medical history and is titrating you ridiculously slowly, you might want to look into a new psychiatrist." this but also have your current doc go over your PDMP with you. It could answer some of your questions.

 

[Benny75]

My psychiatrist pulls monthly reports on me with each refill. One click and they will see what/who/when instantly. I can’t say this for your doctor of course. Be open with your doc. Better than kicking rocks. Best, Benny

 

[idontremember]

Depending on the pharmacy, the pharmacy might put an alert in the system and/or just flat out refuse to fill it. It really depends. If it's a Walmart pharmacy, as an example, I would definitely not do it. They are known to be especially bad about meds like that. Cvs and walgreens are very iffy, it depends on the pharmacist in my experience. In general, pharmacies are becoming more on top of stuff like that. If it does go through, there's a chance it will mess up your regular refill schedule, especially if they are the same medication (you have more of a chance of it not messing it up if one is ER and one is IR. If they are both ER, you're not going to be able to fill the other prescription at the normal time).

Good luck! I'm sorry about what you went through, that's also. I was treated badly for my Kratos addiction as well, but not as badly as you.

 

[transpersonal_psyche]

Thank you all for your compassion and sympathy. Few understand how terrifying this experience was. I'm a proponent of Jungian synchronicity, however, which generally manifests whenever I'm going through a psychospiritual crisis. I got incredibly lucky. The system for treating addiction in this country is absolute trash, at least for those of us dependent on Medicaid.

I've decided not to attempt to fill the script, as I'm sure it would raise red flags. Instead, I've scheduled an appointment with a new psychiatrist for tomorrow. I explained most of my situation (medication history, academic aspirations), but did not mention that I was involuntarily committed for kratom addiction. I'm assuming she'll see it on my record. Fortunately, my current psychiatrist appeared open to prescribing me a booster dose next month. I'm about to start an online statistics course (and I've got a plethora of other clinical, personal, and intellectual responsibilities), as I'm designing a research project in addition to applying to graduate school.

I'm going to meet with the new psychiatrist tomorrow, just to see if she's a better fit. I was on Dexedrine IR for 4 years, so it's not like I'm asking for anything new. I really just need an IR booster, and perhaps 30mg ER instead of 20mg. My concern is that she may request a UA or simply refuse to help if she can see that I was involuntarily committed. I suppose there's no risk in trying. I mean, I still have an old script - it will look good that I haven't attempted to fill it, and it should help my cause If it goes poorly, I'll simply stick with my current psychiatrist. Does anyone know how much client information psychiatrists have access to? Should I expect her to bring up the IC?

I have barely touched on the severity of what I went through. When I began my detox, it triggered a profound "psychospiritual crisis" (to use Dr. Stanislav Groff's neologism). I've been a psychonaut for nearly 20 years; I've explored the depths of ayahuasca, psilocybin, mescaline, LSD, MDMA, 2C-B, DMT, ketamine, and DXM for 19 years. The psychospiritual crisis I underwent was radically psychedelic, and included the experience of dismemberment typical of shamanic initiatory crises. I'm talking two weeks where my perception was completely overridden. The psychedelic qualities were reminiscent of ayahuasca, but far more radical. I can't even begin to explain right now. As most of you know, its ineffable.

I was placed on a 9 month involuntary commitment for kratom and benzos, and spent the final week of my psychospiritual crisis in a detox center for the homeless. My visions became nightmarish, and I experienced extreme torture. In the vision, my skin was peeled back and stapled, my body was dismembered, I purged feces through my mouth, and eventually my entire cognition was dismantled piece by piece. I was not aware that it was simply a vision at the time. Twice over, I felt every phenomenological element of my psyche incinerated until there was nothing left. I remember nothing after the final cognitive objects in my psyche were eradicated. That said, I was brought back by these "entities" in the vision, and was physically and cognitively dismembered again until there was nothing left.

My IC was longer than everyone else I encountered, most of whom made my addiction issues appear relatively benign. I'm talking about people who were injecting alcohol, smoking fentanyl, losing their minds from meth psychosis, etc. Most had spent several year in prison; several came to the program directly from jail/prison. The counselors were less educated than myself (I've got my bachelors in psychology and philosophy). After my crisis, my capacity to balance the restrictive forces of my ego was radically transformed. I feel as though I've been reborn, like I'm rediscovering myself.