ADHD-er here. I have a 2-sigma attention span in the shitty direction. It's a massive impairment. I've titrated my dose, and I've stayed at 45mg Adderall/day for the past 3-4 years, which is quite high for someone who has been careful not to develop a tolerance.

Every month, I have to spend a day (or five) dealing with the nightmare that is filling my prescription so that I can function like a normal human being.

THE RULES:
0. For ADHD people such as myself, being forced to go a day without meds is like being forced to go a day without your favorite text editor. It's not fun. In addition, I don't feel safe driving then. If I want to go someplace without meds, I'm taking a cab.

1. Adderall is classified by the DEA as a schedule II stimulant. Some other schedule II drugs: cocaine, opium, morphine. If you opt for a paper prescription, it usually has security features like microprinting, watermarks, or holograms. You're going to be asked for an id (or three) when you fill the prescription. After all, you might as well be getting a prescription for cocaine.

2. There are no refills on your prescription, ever. You have to get a new prescription every month, which means calling in to your clinic and reciting all of the details. Nurses are not allowed to copy-paste these details, so you can bet your ass that I've dealt with a number of typos over the years. Sorting out typos usually takes a few business days.

3. A doctor must sign each prescription.

4. Some doctors flat-out refuse to sign prescriptions that they didn't prescribe. That's totally reasonable, except it means that you need to call in for a new prescription on a day when your prescribing physician is in the office. That means that you need to either learn their work schedule, or call in at least 3-5 business days before you need to fill your meds.

5. Most insurance companies will not allow you to fill your medication even one day early -- if you want to do that, you're paying the sticker price yourself. For my dose, the sticker price is $500-600.

6. In some states...
- if you send a prescription to a pharmacy, then it MUST be filled there, and may not be transferred.

- pharmacies may not answer questions over the phone about whether medication is in stock. They might be able to answer in person.

- pharmacists may not call other pharmacists or access any sort of database to find out whether there is any pharmacy in the area with medication

- if there is not enough medication in stock, then the pharmacy may partially fill your medication with the available stock, but you void the unfilled portion of your prescription. Your insurance will probably not allow you to fill your meds early, even if the pharmacy is out of stock and you choose to fill a partial prescription.

Remember that you can't bring your prescription somewhere else, or call in advance to inquire about stock. So you have to remember to ask the pharmacist about their stock before you hand the prescription over, in case they don't have enough stock. That gives you the opportunity to blindly search the neighborhood for a pharmacy that has them in stock. Remember, you can't call about any of this, so you're going to be doing quite a bit of travelling.

7. Some pharmacists are antsy about filling a prescription for drugs in the same category as cocaine. I've met pharmacists who will insist upon verifying the prescription with your prescribing clinic. If you try to fill your meds when your prescribing clinic is not open, tough luck. Come back tomorrow.

8. Because of the effects that large-ish daily doses of amphetamines may have on one's heart, most doctors that I've met will insist on meeting with patients every few months to check your blood pressure, heartrate, etc. That is, your prescription is not getting filled unless you make a clinic visit every few months. Because I actually have ADHD, the conversation usually goes something like this:
"Are you having trouble sleeping?" Nope.
"Have you been fidgeting?" Nope.
"Has your heart been racing?" Nope.
"Have you noticed a change in eating habits?" Nope.
"Do you want to lower your dosage?" Nope.

On one hand, I understand why it's smart to keep tabs on my cardiovascular system. On the other hand, it's obnoxious to force me to get a checkup every 3 months just to fill the same prescription that I've had for the past decade.

COMMENTARY ON THE RULES:
Because it's relatively easy to acquire an Adderall prescription, the DEA makes it a pain in the ass to fill it, as a way to restrict the supply for the illegal Adderall market. These rules make it as obnoxious as possible to fill an Adderall prescription.

The thing is, a drug dealer with a bogus prescription isn't going to be too bothered if they're forced to wait a week to get an Addy refill. Sure, it's a loss of income, but it's not going to temporarily ruin their life.

I think the solution here is to make it easier to refill an existing prescription, but make it harder to get one in the first place.

ADHD TESTING:
In particular, I think that people should be required to get formally tested for ADHD in order to get a prescription for amphetamines. Usually, you can obtain a prescription just by telling your doctor that you think you might have ADHD, describing your experience, and then answering some basic screening questions.

But there is a more formal test. At the behest of my parents (who were skeptical about ADHD), I got formally tested. It was a 12-hour test, split up into three 4-hour chunks. I was not allowed to take any stimulant meds (not even coffee) during -or in the 24-hour period before- the test.

The test measured my IQ, short-term memory, and ability to deal with monotonous or distracting tasks.

For instance, one of the tasks was to transcribe a page of symbols using a substitution table. The problem was that the substitution table was printed on the inside front cover of a stapled booklet, and I was transcribing pages inside the booklet. I was not allowed to remove the staples, so I had to flip back and forth a ton. To make matters worse, I had to transcribe each blob of symbols onto the back of the same page. More flipping back and forth.

Another task was to listen to a list of numbers, and recite them back in order, or recite them in reverse order, or recite them in sorted order. The number of numbers that you could recite correctly in the latter two situations was used as a proxy measure for attention span, and for immediate short-term memory in the former situation.

These are exactly the sorts of tasks with which I have severe difficulty.

The test did screen for mental health issues by asking some standard, but nonetheless subjective questions about anxiety/depression/well-being etc.). But on the whole, I thought that the test was largely scientific, and did a good job of measuring my cognitive impairment in a fairly objective manner. Admittedly, the test did not involve any brain scans, so it might not be the best thing available.

But in any case, it would make my life a hell of a lot easier if the inconvenience of obtaining and filling an Adderall prescription could just be front-ended!