Drowned in a Stream of Prescriptions

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Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.

“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”
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more @ http://www.nytimes.com/2013/02/03/u...mphetamine-addiction.html?pagewanted=all&_r=0
 
I think this is a failing of the american health system more than of the kid or big pharma. He did not get the help he needed and the amphetamine prescription kept coming.

Adderall is becoming a joke just like medical cannabis did in the early days.
 
Definitely is a failing of the health system and particularly his prescribing doctor. But seriously, he was seemingly manipulating the system. He has personal responsibility.

That said...

Rest in Peace.
 
Transform said:
I think this is a failing of the american health system more than of the kid or big pharma. He did not get the help he needed and the amphetamine prescription kept coming.

Adderall is becoming a joke just like medical cannabis did in the early days.
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I also think this speaks much more about the American health care system than the "failure" of the kid. When you are released from the psych ward for psychosis and your parents are informing the doctors about the issues they are causing you an amphetamine script shouldn't be forthcoming.
 
Venrak said:
Definitely is a failing of the health system and particularly his prescribing doctor. But seriously, he was seemingly manipulating the system. He has personal responsibility.
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He was manipulating a system that is fundamentally flawed in the first place, not to mention displaying obvious drug seeking behaviour. He shouldn't of been written the scipts he was given if his doctors had done any legwork at all.
 
I agree.

I guess my problem is that it was his choices that ultimately caused this.

Context is important though, and nothing is absolute.

If I were in his situation I would blame myself. Not Doctors. They merely facilitated things.
 
Obviously the blame is ultimately always in the hands of the individual but there are different degrees of complicity and in this case I think the doctors were sufficiently negligent that there should be consequences. When one is in the grips of addiction it is an incredibly.. odd mindset and one desperately needs support and strictness from those who can provide it.

Would he have sought meth if his prescriptions had been cut? Could his parents have done more to help? Could his friends, his school have done something?
 
According to records obtained by Richard’s parents after his death, a nurse practitioner at Triad detailed his unremarkable medical and psychiatric history before recording his complaints about “organization, memory, attention to detail.” She characterized his speech as “clear,” his thought process “goal directed” and his concentration “attentive.”

Richard filled out an 18-question survey on which he rated various symptoms on a 0-to-3 scale. His total score of 29 led the nurse practitioner to make a diagnosis of “A.D.H.D., inattentive-type” — a type of A.D.H.D. without hyperactivity. She recommended Vyvanse, 30 milligrams a day, for three weeks.

Phone and fax requests to Triad officials for comment were not returned.

Some doctors worry that A.D.H.D. questionnaires, designed to assist and standardize the gathering of a patient’s symptoms, are being used as a shortcut to diagnosis. C. Keith Conners, a longtime child psychologist who developed a popular scale similar to the one used with Richard, said in an interview that scales like his “have reinforced this tendency for quick and dirty practice.”
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If they are giving speed to anyone who answers yes on the test, I would say that the system holds a great deal of responsibility.
Part of the blame has to go to the lack of accurate information surrounding drugs, as seen in this quote from the article:

“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”
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Part of the blame certainly belongs with the man himself, but I still feel bad for him.
The problems with the system are deep, and most doctors don't admit them:

Almost every one of more than 40 A.D.H.D. experts interviewed for this article said that worst-case scenarios like Richard Fee’s can occur with any medication — and that people who do have A.D.H.D., or parents of children with the disorder, should not be dissuaded from considering the proven benefits of stimulant medication when supervised by a responsible physician.

Other experts, however, cautioned that Richard Fee’s experience is instructive less in its ending than its evolution — that it underscores aspects of A.D.H.D. treatment that are mishandled every day with countless patients, many of them children.

“You don’t have everything that happened with this kid, but his experience is not that unusual,” said DeAnsin Parker, a clinical neuropsychologist in New York who specializes in young adults. “Diagnoses are made just this quickly, and medication is filled just this quickly. And the lack of therapy is really sad. Doctors are saying, ‘Just take the meds to see if they help,’ and if they help, ‘You must have A.D.H.D.’ ”

Dr. Parker added: “Stimulants will help anyone focus better. And a lot of young people like or value that feeling, especially those who are driven and have ambitions. We have to realize that these are potential addicts — drug addicts don’t look like they used to.”

Documentary screening and panel discussion on ADHD, “ADD and Loving It?!”

Listing, The Virginian-Pilot

Oct. 10, 2012

The Fees decided to go. The event was sponsored by the local chapter of Children and Adults with Attention Deficit Disorder (Chadd), the nation’s primary advocacy group for A.D.H.D. patients. They wanted to attend the question-and-answer session afterward with local doctors and community college officials.

The evening opened with the local Chadd coordinator thanking the drug company Shire — the manufacturer of several A.D.H.D. drugs, including Vyvanse and extended-release Adderall — for partly underwriting the event. An hourlong film directed and narrated by two men with A.D.H.D. closed by examining some “myths” about stimulant medications, with several doctors praising their efficacy and safety. One said they were “safer than aspirin,” while another added, “It’s O.K. — there’s nothing that’s going to happen.”

Sitting in the fourth row, Mr. Fee raised his hand to pose a question to the panel, which was moderated by Jeffrey Katz, a local clinical psychologist and a national board member of Chadd. “What are some of the drawbacks or some of the dangers of a misdiagnosis in somebody,” Mr. Fee asked, “and then the subsequent medication that goes along with that?”

Dr. Katz looked straight at the Fees as he answered, “Not much.”

Adding that “the medication itself is pretty innocuous,” Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it “something that they need.”

“If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”
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^ Wow. That's not a well informed approach of addiction as a public health issue.
The end of the excerpt is actually a rhetorical gem:
Adding that “the medication itself is pretty innocuous,” Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it “something that they need. If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”
 
The evening opened with the local Chadd coordinator thanking the drug company Shire ?€” the manufacturer of several A.D.H.D. drugs, including Vyvanse and extended-release Adderall ?€” for partly underwriting the event. An hourlong film directed and narrated by two men with A.D.H.D. closed by examining some ?€œmyths?€ about stimulant medications, with several doctors praising their efficacy and safety. One said they were ?€œsafer than aspirin,?€ while another added, ?€œIt?€™s O.K. ?€” there?€™s nothing that?€™s going to happen.?€

Sitting in the fourth row, Mr. Fee raised his hand to pose a question to the panel, which was moderated by Jeffrey Katz, a local clinical psychologist and a national board member of Chadd. ?€œWhat are some of the drawbacks or some of the dangers of a misdiagnosis in somebody,?€ Mr. Fee asked, ?€œand then the subsequent medication that goes along with that??€

Dr. Katz looked straight at the Fees as he answered, ?€œNot much.?€

Adding that ?€œthe medication itself is pretty innocuous,?€ Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it ?€œsomething that they need.?€

?€œIf you misdiagnose it and you give somebody medication, it?€™s not going to do anything for them,?€ Dr. Katz concluded. ?€œWhy would they continue to take it??€
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Are you kidding me? This blows my mind, that supposedly legitimate doctors can spew absolute garbage like that. The doctors, the psychiatrists, they might be academically trained but most of them know very little about real drug use. Yet the public treats them like they're omniscient and has given them absolute power over our drug choices.
 
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“If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”
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Easy access to adderall (I got it for free from a kid who HATED taking them everyday) led me to a very serious ecstasy, and eventual methamphetamine addiction.



It is NOT a toy, and should NEVER be given to children. It's fucking amphetamine, not something that should be used to pacify a generation.
 
Fuck the doctors, fuck the psychiatrists, they might be academically trained but most of them know fuck all about real drug use. Yet the public treats them like they're omniscient and has given them absolute power over our drug choices.
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I feel the same way.
Doctors should get paid the same as teachers. Somewhere in-between what the two make now.
80 grand a year, maybe? It would make for a lot more good teachers. And doctors treated as less omniscient than they are now.
Medical school costs would drop. I see potential drawbacks, but mostly I think that it would be good.

It is NOT a toy, and should NEVER be given to children. It's fucking amphetamine, not something that should be used to pacify a generation.
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Absolutely agree with this.
Parents and teachers often want to simply pacify children.
As a parent and teacher, I understand this desire, but I put in the extra work and challenge them.
(If I were making 80 grand a year, I might do even better! ;))
 
i didnt read but one or two sentences cuz this kinda caught my eye n threw me off

he was going to DOMINION psychiatrics associates

i dont really trust the pharm industry n alot of Dr.s as it is

but dominion, jesus christ that'd be a turn off for me if i was seekin mental health help
 
Transform said:
Adderall is becoming a joke just like medical cannabis did in the early days.
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I used to think that doctors like to throw random Anti-depressants at you because they got a little extra under the table for doing so. In recent years I have come to find that in my peer group alone 7/10 people are RX'd some sort of psychostimulant for their ADD/ADHD. I can't sit here and say with good conscience that my peers don't need this, but honestly... they really don't.

Most of them have them stockpiled or use them as intense study aids, going on 3-5 day benders of nothing but studying and occasionally some physical activities/socializing. Something that was actually pretty scary to me was when a really close friend of mine who gets RX'd Desoxyn took 5 or the 5mg pills at once. I told him that was a bad idea, not thinking it was his usual, and I ended up getting scolded by him (because of his knowledge of my prior drug use with heroin/painkillers. I was informed that at least in his case, he was benefitting from the influence of prescription methamphetamine, whereas I just degenerated and gave myself a bad name.

I have dealt with ADD for years, and have been through all the psychostimulants I can think of except desoxyn, and honestly the only thing that makes me feel better at this point is the fact that I have learned to cope without any stimulation to help fuel my intellectual prowess and want for new abilities and more knowledge. I think the final straw for me is when I was switched from the Generic COR 135 pink 20mg adderall to the horrendously shitty 70mg Shire Cashcrop that is Vyvanse. Horrible prodrug, horrible horrible prodrug.

Either way I feel for Richard in the article. Overworked as a student and turned to stimulants to better his chances at succeeding in life. It is like they want us to fail or be severely depressed. Bastards.
 
Diloadid said:
Overworked as a student and turned to stimulants to better his chances at succeeding in life. It is like they want us to fail or be severely depressed. Bastards.
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It is a bold comment to make that by not prescribing amphetamines a doctor wants you fail or be severely depressed.

I think it is a safe wager that the majority of people who have "made it" in life didn't require daily doses of amphetamine.
 
slimvictor said:
I feel the same way.
Doctors should get paid the same as teachers. Somewhere in-between what the two make now.
80 grand a year, maybe? It would make for a lot more good teachers. And doctors treated as less omniscient than they are now.
Medical school costs would drop. I see potential drawbacks, but mostly I think that it would be good.
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Just move to Ontario or Alberta! The average salaries for teachers are over $80,000 per year in both those provinces.

I disagree with equivalent salaries for teachers and doctors, though. The training needed to become a doctor is leaps and bounds more difficult and consumes many more years than a teacher's formation.
 
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