Silk Road forums
Discussion => Drug safety => Topic started by: fractalglobal on November 07, 2012, 03:16 am
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I've just found out a friend of a friend of mine(really) is taking 120mg+ of adderall per day on prescription. My initial reaction to this was a massive "what the fuck, that can't be healthy."
I haven't taken adderall much myself, and I haven't found any dosage conversion tables that look legit so I figured an illegal underground drug market would be the best place to look for safe advice.
He's found that less than 60mg does not give him the level of focus he needs to operate efficiently. He also understands that all suggestions are not medical suggestions and shouldn't not be taken as such, unfortunately he lives in a place where getting quality medical advice is near impossible.
Hes roughly 180-220lb and eats fairly healthy/exercises.
I told him that the dosages he takes seems pretty unhealthy and is probably trashing his liver/kidneys, I offered some suggestions to reduce dosage.
So far I've suggested:
-Magnesium supplements
-Increase blood PH through diet/drink a bicarb/water mix 45 mins before dosing
-prepare tablets for sublingual ingestion, taught him to take sublingually, breaking up doses into 4 lots taken over 4 hours.
-take week long break from amphetamines to reset body tolerance(he hasn't tried this due to external factors)
Anyone got thoughts? He doesn't get any really worrying side effects from his current large dosage but this doesn't necessarily mean that it isn't having a negative effect. He has to take the medication due to (non ADD/ADHD) mental disorder, otherwise he cannot work.
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It's really quite the opposite actually, this forum is one of the worst places to ask for drug advice. Sure there's a lot of people here with extensive experience, but it's also home to some of the most immature attitudes towards drug safety that I've ever seen.
As you already know, 120mg of Adderall is an insane daily dose and I strongly suggest he cuts that by at least half. The obvious answer you're overlooking is for him to GO AND SEE A DOCTOR and explain his current situation. He'll experience some withdrawal-like symptoms, probably extreme fatigue and migraines for a few days/weeks.
As for specific drugs that may help, something like Wellbutrin might alleviate some of the addie withdrawals he'll probably experience.
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The obvious answer you're overlooking is for him to GO AND SEE A DOCTOR and explain his current situation.
He also understands that all suggestions are not medical suggestions and shouldn't not be taken as such, unfortunately he lives in a place where getting quality medical advice is near impossible.
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The obvious answer you're overlooking is for him to GO AND SEE A DOCTOR and explain his current situation.
He also understands that all suggestions are not medical suggestions and shouldn't not be taken as such, unfortunately he lives in a place where getting quality medical advice is near impossible.
If he can get a prescription for that much Adderall, then he probably can find reliable medical help. Where exactly do you live?
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He's prescribed a specific dose of a medication by a licensed medical practitioner. True, some of them are fucking morons just like any other profession. But generally speaking, they rarely do things that fuck their patients up (even if only to avoid law suits).
120mg per day is a very high dose. The PDR (physician's desk reference) recommends 40mg/day as the max. That's pretty conservative these days though. Don't worry, it's not going to kill him. He should be fine long-term so long as he doesn't deviate from the doctor's prescription regimen. He will definitely have withdrawal if he stops abruptly though. Same symptoms as meth withdrawal. Exhaustion (possibly severe), lack of motivation, and extreme hunger are pretty common. Some people also experience anxiety and extreme restlessness. Basically it's unpleasant and can easily keep you from being anything resembling a functioning person for a couple of days or up to a week if he's unlucky.
Amphetamines are the one drug I have interest in. The rest don't tempt me in the least. Don't even care for the way they feel. Well... okay, PCP was kind of fun, lol. But my point is that I've done quite a bit of reading up on amphetamines, and he'll be fine. Biggest risk at 120mg/day long term is eventual dependence (addiction), IMHO.
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I wrestle with the same problem. Its just something you'll have to deal with Im affraid. Most Doctors are to scared they might lose their license if they prescribe Desoxyn thanks to the DEA for any reason.
Someone on the forums suggested taking a Magnesium + zinc supplement , and I was surprised by the results: I only had to take 1/2 of what I usually did in a day. But that too lost it's kick.
Finding a knowledgable Dr can sometimes be more of a problem- its the nature of amphetamines for the user to build up tolerance, its not some kind of lack of willpower or the person being a feind- a good Dr will know this and be able to present alternatives.
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Yeah, sadly amphetamines are one molecule that your body gets really good at tolerating really quick... tolerance to the appetite suppressing and mood-enhancing effects of amphetamines develops very rapidly but tolerance to the waking-up and improved focus effects takes longer and never gets as bad. So you'll eventually be in the same mood and eat just like normal at 120mg/day, but you'll still be getting a sizable concentration boost & have difficulty sleeping if you take it at night.
Well, that's what they say at least. I'm not gonna defend it either way. That is the justification behind it being a good medication for long-term ADHD treatment though; still, MrGuy's right: he could ask about switching things up if he wants after awhile, or not take it on the weekends at all; but you can just stick to one dose forever and keep getting benefits from it. If you play with it though & have fun, your tolerance will go up and then you'll lose the effect at your prescribed dose, basically. Which is why it's important to do what the doc says if you're smart and healthy and all that :)
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Anyone got thoughts? He doesn't get any really worrying side effects from his current large dosage but this doesn't necessarily mean that it isn't having a negative effect. He has to take the medication due to (non ADD/ADHD) mental disorder, otherwise he cannot work.
Ok, so this started out as a brief response but turned out to be more of a PSA bulletin.
Summarize version is at the bottom. :)
Yes, you're friend's prescribed dose is quite high, well above most guidelines, but not uncommon. Safe? It could be. For some individuals it is. That decision is made between the patient and provider. Individual response and tolerance to stimulants varies widely between individuals according to a variety of factors, as due prescribing habits. Unfortunately prescribing habbits aren't always professional and patients are not always honest. In any case, you're friend has been open with you and IMO you're concerns are justified.
I'd strongly discourage the idea of baking soda to tinker with pH. If you're concerned about the dose and his health, this is only fueling the fire if you think about it. I've experimented with this myself in the past and nothing desireable ever came of it. It's more of a occasional/recreational purpose idea (and a bad one ime) and probably a bad idea for daily/therpeutic purposes. Simply avoiding acidic food/beverages around doses would be a wiser strategy.
I agree on taking a break from stimulants/drug holiday, but it doesn't sound like that's going to happen here.
The important thing is that his prescribing physician is monitoring him properly. By that I mean annual or semi-annual bloodwork & a thyroid hormone screen, but MOST importantly *regular* blood pressure checks at every visit. Unfortunately some providers omit this because they're no more than pricey vendors.
Given his high daily dose, he should be monitoring his own blood pressure regularly (or at least instructed to). Because you didn't mention it, I'm assuming it wasn't encouraged by vendor (let me guess, he takes cash only?)...anyway...
*REGULAR blood pressure monitoring* is the single MOST important thing that YOU can encourage as a caring friend (and really the only thing to be concerned about if insists everything else is fine and you agree).
If you have the tools check his blood pressure yourself, then do it or teach him how. If not, do it with one of those automated machines available at most pharmacies. If you can't convince him to do it on his own, do it for him/accompany him. Hit up the pharmacy together whenever your out and about.
How should one go about monitoring blood pressure in this scenario?
Ideally, you'll want find out what his baseline blood pressure runs before he takes his meds. Make sure he's relaxed. Take it a couple times (preferably on different days as well) to get the most accurate reflection of his baseline blood pressure. 120/80 or less is considered ideal.
Again, that's ideal. More importantly, check his blood pressure after he's taken his meds. Again, it would be ideal to do so on a couple seperate days to get an accurate reflection of his average blood pressure while the medication is in effect. Most likely he takes multiple doses, so check it in the afternoon and again after his final dose if possible. Do it as often as possible at first and keep a log of your recoridings.
If you can manage to get recordings 2-3 (or more) in a week for starters, that is ideal and you'll have established a pretty good average of his baseline blood pressure both pre and post medication.
Our blood pressure (with or without meds) fluctuates quite a bit according to a variety of factors (activity, stress/anxiety/mood, nicotine, lots of variables can effect it at any given time), that's why it's much more useful to get several recordings at different times/occasions to establish a more accurate baseline. That's why his physician should encourage him to monitor his BP independently at such a high dose, even it is being checked at every appointment/followup visit. The reality is that a single BP check means fuck all (unless it's dangerously high).
Again, the above is ideal. At the very least, just do the best you can to establish his average blood pressure while medication. Even if only a couple times a week is the best you can do.
THEN, after you've established baseline, you can lay off a bit if everything checks out normal. After that, a weekly reading or two should do, maybe monthly if he's really uncooperative or if past readings were all good. I'm sure you get the picture. The more frequent the better but make do with what you can :)
-Normal blood pressure is 120/80. A few points high on either side is generally not a big deal and may be expected, especially when stimulants are in effect, the body isn't totally at rest from activity, or other drugs like caffeine or nicotine are active in the system.
-If you find his average resting bloodpressure to consistantly run more than a few points beyond normal (ie- 120-140/80-89), that's pre-hyper-tension and for the sake of his long term helath, your friend should make it a point to discuss this during his next visit. No need to freak out by any means, but do adress it in the near future.
-If he's consistantly reading in the range of 140+/90+, then he is dealing with hypertension and it must discussed at his next visit, or even sooner (especially if well above those numbers). More significiant in terms of long-term health, again increasingly so with greater deviation.
-If resting blood pressure *ever* approaches a range of 180+/120+ (even on a single occasion) then that is life threatening territory and he must seek medical attention immediately and without delay. Because in this range it's no longer about long-term health consequences, we're actually facing accute/immenant organ failure/ and or death without medical intervention (usually as simple as a pill). With pressures that high, death is common for those who delay treatment.
Now, I understand the aspect of psychological dependence that comes with stimulants. If it turns out that his blood pressure is cause for concern, he may be reluctant or unwilling to acknowledge/accept it as a problem and refuste to discuss it with his physician/seek help due to fear of his prescription being reduced/revoked.
If it turns out to be the case, he (or any of you out there!) may find it comforting to know that high blood pressure doesn't mean that his stimulant Rx days are over! Drugs like Guanfacine (brand name Tenex, and the extended release Intuniv) and other alpha 2 receptor agonists can be (and are!) used in conjunction with stimulants to effectively counter unwanted side effects (hypertension being one of them)...AND augment therapeutic action of the stimulant itself.
And if the prescriber isn't willing to work out a regimen compatible with both his immediate ADHD & long-term health needs or provide a referal to one who can, then it's time to look elsewhere because there are competant providers out there who specialize in such management.
Hope that helps.
tl;dr- Yes, 120 mg is high, but not uncommon. If all else appears fine, regularly monitor blood pressure. Probably the single most important thing to be concerned about. Very easy to do. If blood pressure is fine, probably nothing else for you to be concerned about.