I am 47 yo and a mother. I was diagnosed while in college and have been taking Adderall ever since. Over the years my dosage has increased. My last doctor left the practice and I am having a hard time finding a doctor who will prescribe my dosage. 30mg 3 x/day. I understand this is high, but I have been on the medication for over 20 years. It has been years since the dosage has increased, as this has worked for me. My life is falling apart in front of me since not having my meds. Does anyone else struggle with this and, if so, what can be done? I know I can’t just call doctors to see if they will prescribe this much and I also don’t have the time to go to every doctor and psychiatrist in town just to be told they won’t do it. I am not sure what to do at this point. Any suggestions?
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SaagAloo
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Hello SaagAloo, I am sorry to hear that as a result of your doctor moving practice you are running into problems with continuation of a long-established medicine regimen that you have been happy with. Like may adult ADHDers, I received push-back from my primary care provider about diagnosing and prescribing stimulants and it took some determined self-advocacy to connect with a prescriber (psychiatrist) who was happy to move things forward. My primary care physician stated that my age was a concern and the fact that I have high blood pressure. I think in general adult ADHDers experience stigma and judgement and there is a suspicion for things like potential "drug seeking behavior". My primary care provider also told me that ADHD is not a "medically necessary" condition as it is more a "learning disability" than a medical condition, so she was in general skeptical. She mentioned that "now everyone wants to be diagnosed with ADHD".
My psychologist also suggested that I try one of the telehealth prescribers. I was reluctant to do this because I wanted all my care to be centered around my primary care physician, and my insurance was not accepted by the telehealth providers.
None of this helps people who are sincere in their desire to overcome the disadvantages of ADHD and make the most of their lives.
You are also requesting someone taking over prescribing a 90mg dosage that is significantly higher than the stated maximum dose which is 40mg, even though it has historically worked for you. Most doctors will be reluctant to take responsibility for prescribing over the manufacturers maximum dose as this brings with it some potential legal liability issues. There has also been a great deal of publicity surrounding over-prescription of controlled substances including stimulants for ADHD and opiates, so many doctors are becoming increasingly cautious. You and your previous doctor had established a trusting relationship over many years and it must be tough to lose that, but now you need to build a similar trusting relationship with a new physician and it will take a bit of effort to establish that.
When I was getting push back I explicitly asked my primary physician and initial psychologist (not an ADHD specialist) why they were reluctant to do a work up for ADHD and why they were not referring me to a specialist. I asked specifically if there was a trust issue. I put this out in the open to understand if the push back was a kind of blanket response to deter drug seeking behaviour. I also started to track my blood pressure every day to show that I was prepared to be a partner in my own care and monitor any areas of risk closely, and I communicated this to my primary care physician. I documented my history of symptoms and all the things that had not worked (SSRIs, propranolol etc). She reluctantly made a referral to a psychiatrist who after talking with me for about 15 minutes was confident this was the right path, and then everything worked out and I am now doing well on medication.
It's hard to know how to overcome push-back other than to make your case by presenting as much supporting information as possible. To receive a higher than maximum dose a prescriber will need to be prepared to take the long-term risk, and also make sure that you are aware of the long-term risks and equally prepared to take that on in a way that leaves them without liability. I am glad now that I did not quit with my existing provider who despite the push-back I like and has been good with my other care (mostly high blood pressure high cholesterol etc). I could have started looking for another provider which takes time and effort. She is now happy to include discussions about ADHD and continuation of medicine, although it took a psychiatrist consultation to get there.
I hope that you can find another doctor in your current practice that can access your history easily and at least put you on the maximum dose until they take the time to get to know you and create a plan to increase to your previous dose under close supervision. I guess what I am saying is try to sit down with someone and have a proper open conversation about what you really need for your life and mental health. Continuation of an existing medication should not be such a hassle!
have you thought about trying the ER (extended release) version? The dose would be higher than 30 more than likely, but probably less than 90 that you are taking… but it’s supposed to last all day.
everyone seems to be replying with a long form essay. I’m also on a relatively high dose. My psychiatrist said that the body builds tolerance to stimulant meds and suggested I take a day each week where I take a drastically reduced (or no) dose and just “ADHD” for a day. Best advice ever.
My original prescriber, not the one who diagnosed, retired took me a couple years to care, i found a PA, who I loved, set me on the dose I take now after a couple years seeing him, he left his practice suddenly. My current NP had no problem continuing my treatment, I chose to start lower and increase back to my 30mg twice a day. Maybe look at something like that. Talk to the potential provider, with your prior records and show them you understand this is a touchy medication and your willing to work with that, in a reasonable way, and set up a review schedule. I did not think my dose was that odd, until reading these posts.
Thank you for contacting CHADD’s National Resource Center. I want to express my empathy for the difficulties you're facing in finding a healthcare provider who can continue prescribing your current dosage of Adderall. It must be incredibly frustrating and stressful to experience such disruptions in a treatment plan that has been stable and effective for over 20 years.
Managing ADHD medication can indeed be challenging, especially when changes occur with healthcare providers. Many individuals with ADHD find themselves in similar situations when their trusted doctors leave practices or retire. It's essential to explore options that may help you find a solution:
Firstly, consider seeking out doctors or psychiatrists who specialize in ADHD treatment. These specialists are often more familiar with higher doses and may be more open to discussing your specific needs and treatment history. Patient advocacy organizations focused on ADHD can also be valuable resources. They may offer guidance, referrals, or support in finding healthcare providers experienced in managing higher doses of ADHD medications.
It could also be beneficial to gather your medical records, especially those documenting your history with ADHD and the effectiveness of your current dosage. These records can provide new healthcare providers with essential background information to better understand your situation.
Given the rise of telehealth, consider exploring remote consultation options. This approach might expand your possibilities for finding a healthcare provider who is willing to work with your current treatment plan. However, keep in mind that exploring telehealth options are fine as long as the initial visits are in person and once a treatment plan is in effect that telehealth options can be used for the management.
I encourage you to connect with online or local support groups for individuals with ADHD. These communities can offer valuable insights and recommendations based on their own experiences in managing medications and navigating healthcare systems.
Please remember to be patient and persistent in your search for a healthcare provider who aligns with your treatment needs. Finding the right doctor is crucial for your health and well-being, and advocating for yourself is essential during this process.
I sincerely hope these suggestions provide some guidance and support as you navigate this challenging situation. Please know that you're not alone, and there are resources and options available to help you find a solution that works best for you.
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