The headline is so odd! Adderall is not sold in Mexico and the article mentions this several times. It's of course unfortunate someone would buy the wrong drug. The bigger headline is buried which is that people mistakenly bought fentanyl instead of other painkillers (which are actually legally prescribed). This is a much more deadly mistake.
I just came back from Puerto Vallarta, and it's shocking how pharmacies advertise their drugs to tourists. I'm talking massive signs with every prescription med under the sun-- Adderall, Xanax, Retinol, you name it. All next to the HGH and testosterone posters featuring unreasonably muscular bodybuilders.
My roommates in college were amateur body builders and used to go down to Mexico in the early aughts to get testosterone and bring it back since they were starting to clamp down on the abuse of it here.
They stopped doing it when two things happened.
A) One of their buddies who they lifted with got a counterfeit batch of T and got really sick and spent two weeks in the hospital.
B) Some of the guys at the gym were bragging they were getting T from Mexico too, but would buy it with counterfeit $100 super bills they got somewhere in Vegas (still have no idea how they got them) and then would bring their T back and sell it for a huge profits to other bodybuilders who didn't want to risk getting caught at the border. They eventually did got caught and did several years in a Mexican jail.
Now you just have to go to your doctor and tell him your sex drive is down or you have ED and they'll put on you on TRT pretty quickly without all the fuss. Its pretty standard now for older men to be on a TRT regiment.
It's true! In many parts of Mexico, including Mexico City, this is not the case at all. Even in Guadalajara, which is in the same state as PV, you can't buy this stuff without a prescription. But I was in PV and my partner had a headache so we wandered into a pharmacy in an upscale neighborhood to buy some ibuprofen and to our surprise the pharmacist was a hell of a saleswoman! We walked out with a variety of benzos and boner pills.
> it's shocking how pharmacies advertise their drugs to tourists
I’ve been there and a number of other tourist traps in Mexico, none of it is even close to legit. I would trust a drug dealer on the street over a Mexican pharmacy.
The shock you felt is a bit like the shock many foreigners feel when visiting the US, and seeing a consistent flow of television commercials with “Ask your doctor about X.” (Direct marketing of prescription drugs is banned in most of the developed world.)
I also just don't understand how it's profitable to run those ads in the US, given how niche some of the conditions are...like I'm pretty sure that if you have cancer, you're going to be asking your doctor about a lot of things anyway. What's the point of advertising cancer / lupus / drugs that extremely specific conditions that <0.1% of the US population have?
The worst discussions we have on Hacker News are around healthcare and medicine.
For some reason the community refuses to apply a high of research and rigor to this topic, as if it's lesser than the non-sense we call computer science.
This entire debate is comical, the medical community's approach has been, by it's own admission, to throw various stimulants at ADHD. Methylphenidate, L-Amphetamine, D-Amphetamine, Lisdexamfetamine, etc.
By in large, everyone on this thread is pretending like there is a treasure trove of research demonstrating the superiority of Adderall (a racemic mixture of L & D amphetamine) to Methylamphetamine.
And that's just not true at all, there is a paucity of research on the subject. Meth = Bad because of the Germans and street drug users (who smoke an uncontrolled amount).
I get tired of people that don’t have to deal with ADHD trying to apply some sort of morality to stimulants to treat the condition.
If something else actually worked people would gladly try it. Stimulants have so many downsides and side effects that most would never take it unless it was necessary for them to function. These people are not junkies looking to get high.
Not too surprised to see people say here stuff like “isn’t adderall just meth” dose and delivery methods are completely different.
What would it take to make consumer systems to characterize molecules to see if they conform to a particular spec? The FDA et al are great and all if you live in the nice places of the world. They aren't so great for the rest of the world.
I'm decently sure that there is a dosage for methamphetamine for which the effects are (nearly) indistinguishable from "regular" d-amphetamine, assuming that the route of administration is the same.
Obviously not good, I’m just being a little glib. If correctly dosed I suppose people would be getting a somewhat more effective medication than they thought they were getting. Those who were getting caffeine or ibuprofen, not so much.
I was thinking of user surveys. There was a Slate Star Codex/Astral Codex Ten article that goes through different ADHD medications, and those who take Desoxyn report being happier with their medications performance. The article notes all the reasons to be skeptical, but there is some reason to believe meth is a better ADHD drug than Adderall.
As far as I could tell reading that DEA memo, they were being really sneaky with what they said. None of the pill manufacturers had hit their allotment, but they didn't say anything about the raw ingredient manufacturers which are under a different quota. And most of the shortages I've seen in the FDA shortages database were listed as 'shortage of active ingredient'. (Or 'demand increase', which isn't specific enough to know that it's not literally the same thing.)
They were claiming that specific manufacturers had not used their allotted cap, so they refused to raise the cap of other manufacturers that had reached their cap.
While I agree they should have mentioned Desoxyn - which is even FDA-approved for treating the same condition, ADHD, as Adderall is - nothing makes it okay for a pharmacy in any country to make people think they’re buying one medication when they’re actually getting a different one.
Reactions to ADHD meds vary widely among people with ADHD. Just because Desoxyn and Adderall are closely related doesn’t mean that a person who has good results with one will also get those good results with the other, especially not necessarily using the same dosage and timing.
All of this assumes they’re selling legitimate pharmaceutical methamphetamine with as much official oversight as other prescription drugs in Mexico. If this is black market meth, it’s even worse due to the unpredictable quality, purity, fillers, and dosage that come with the black market.
> If the author weren't trying so hard to scare-monger
Uhhh I am a biochemist and I think being sold methamphetamine as Adderall is completely problematic. Under no circumstances is that okay, and it's potentially quite dangerous. Completely unacceptable.
I don't see how it's relevant. The counterfeit adderall being sold isn't pharmaceutical grade meth. People buying black market sealed bottles of adderall would probably want to know that it's likely not adderall.
I think it's relevant because to me the article isn't actually about Adderall vs meth, just using that as the framing for a story about why they think it's bad for anything pharma-related to happen out from under the watchful eye of a US-like medical-industrial-congressional complex.
The author is preying upon readers' cultural understanding of meth (via the news media and shows like Breaking Bad) as something inherently dirty, something for which there is no possible safe usage. The existence of FDA-approved meth ruins the framing even if FDA-grade is not what a buyer would be getting.
I'm a biochemist and I completely disagree with your take.
There are very few situations where prescribing methamphetamine is reasonable. It's a niche drug. Even XR formulations of Adderall are considered a blunt instrument compared to more recent alternatives.
The issue is one of trust, integrity, and safety. Pharmacies should not operate like drug dealers.
Did you mean IR formulations, or are you saying that extended release formulations of Adderall are considered a blunt instrument? Compared to what other than Vyvanse?
IR (instant release) is the opposite of XR (extended release). I said and meant XR. I don’t even think IR should be used anymore, except maybe in super niche situations (I’m not even sure if I can think of any situation where it makes much sense… maybe narcolepsy?).
XR is obviously preferable to IR, but amphetamines have been falling out of favour over the years (it’s a slow trend). Vyvanse, NSRIs and even SSRIs tend to be regarded more and more favourably compared to amphetamines (Adderall) and methylphenidate (Ritalin).
(Disclaimer: I myself take Adderall XR 10mg as prescribed, so I have the opposite of a conflict of interest in this context.)
This is the weirdest, worst take I've read today. Yes, meth can be sold by prescription in the US.
Why you think that's relevant to a Mexican pharmacy selling meth as a completely different medication, and then having the audacity to call it "scare-mongering", is truly bizarro to me. I mean, fentanyl is commonly used as a prescription medication in the US. Would it be "scare mongering" if a journalist reported that a pharmacy sold fentanyl as Xanax without mentioning fentanyl can be used by prescription in the US? Why do you think that even matters?
> Would it be "scare mongering" if a journalist reported that a pharmacy sold fentanyl as Xanax without mentioning fentanyl can be used by prescription in the US? Why do you think that even matters?
Fine, I just read it. It still makes no sense. You have latched on to the fact that meth can be sold with a prescription in the US. It's still totally irrelevant to the issue at hand.
>> If the author weren't trying so hard to scare-monger
Just read this article on The Atlantic and I would be scared considering what's passing for meth is considerably stronger than what people think nowadays:
This article is peak scaremongering. At this point, cartel meth is approaching 98% purity. Given sufficient purity, it doesn't matter the synthetic pathway as the end result is the same.
But by 2014 the new meth was everywhere. When that happened, “it seemed that people were losing their minds faster,” a Los Angeles Police Department beat officer named Deon Joseph told me. Joseph had worked Skid Row for 22 years. “They’d be okay when they were just using crack,” Joseph said. “Then in 2014, with meth, all of a sudden they became mentally ill. They deteriorated into mental illness faster than I ever saw with crack cocaine.”
Susan Partovi has been a physician for homeless people in Los Angeles since 2003. She noticed increasing mental illness—schizophrenia, bipolar disorder—at her clinics around the city starting in about 2012. She was soon astonished by “how many severely mentally ill people were out there,” Partovi told me. “Now almost everyone we see when we do homeless outreach on the streets is on meth. Meth may now be causing long-term psychosis, similar to schizophrenia, that lasts even after they’re not using anymore.”
Drugs that cause psychosis much faster than ever before? Yeah, you're right, nothing to see here.
Newsflash---stimulants are prone to give people stimulant psychosis. Rising meth usage leads to rising psychosis. Again, with cartel meth approaching 98+% purity, the synthetic pathway doesn't really matter much anymore.
Have you ever tried meth? I feel like you’re demonizing meth. There is someone reading this who needs meth to function and you’re comparing their prescription to rubbing alcohol.
Meth has higher user ratings on Drugs.com for treating ADHD than dextroamphetamine or Adderall etc have. If it weren’t for the side effect profile and potential for abuse, I reckon it would be the mainline treatment.
I empathize and understand what you mean though. When others say you’re basically on meth, that must not feel good.
There's no way. I snorted a bump of approximately 50mg, at the most, off of my hand and was completely jacked for 48 hours. It was the most uncomfortable speedy high I've ever experienced. I drank an entire case of beer trying to come down and it did almost nothing. I've gone through a gram of coke in a night, snorted and/or smoked, and it was nothing compared to meth. I'm on 30mg Adderall daily and I can sleep just fine.
I remember thinking "Why would anyone want to feel like this?" Will never touch the stuff again.
You're right, sorry. The point of their analogy is that they aren't similar, because they're pointing out the parent comment's analogy is likewise bad.
A lot of people that have tried both meth and amphetamine in comparable dosages would tell you they are very comparable, though.
Rubbing alcohol is isopropanol. Drinking alcohol is ethanol.
You can get “industrial ethanol” that has some methanol added to prevent people from consuming it, and pay liquor tax on it. These are for chemists for specific applications.
Rubbing alcohol, in the US at any rate, is isopropanol and vodka is ethanol. You're probably thinking of denatured alcohol which is ethanol with methanol added.
Adderall is normally prescribed in the XR formulation (meaning it's an extended/slow release capsule), and has amphetamine as the active ingredient.
Methamphetamine is a different molecule altogether, and typically it's not packaged in slow-release capsules.
Yes, methamphetamine is structurally related to amphetamine, but you shouldn't make the mistake to think they are interchangeable. Very often the difference between two very similar molecules is the difference between life and death (for a classic example, look up the two enantiomers of thalidomide).
Adderally XR formulations are still a minority of prescriptions.
Talking about methamphetamine as a different molecule is not helpful, as Adderall itself is not a single molecule.
Which I suspect you know, as you mention different enantiomers of thalidomide. However you don't point out that adderall itself is a 3:1 racemic mixture of l and d amphetamine.
The real discussion here is the receptor binding affinity of the various targets of the drugs, and how they compare.
There's a whole section, "Single-Isomer Versus Racemic Formulation", in this recent review article titled "Novel Formulations of ADHD Medications: Stimulant Selection and Management"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8412159/
They are very similar, but the euphoria with Adderall is significantly less than with meth or other speed you'd buy on the street. For some people meth might be an effective substitute, but I think most people would find the high and the side-effects too distracting. Plus, that euphoric high increases the likelihood of abuse and addiction.
I'd add that the people I've known who did a lot of meth tended to have physical health issues and looked like shit, which was not the case with the people I've know who abused Adderall.
Method of administration affects the time delay for euphoria. Smoke > Shooting > Eating.
People who do a lot of meth (or drugs outside of a prescription) tend to do as much as they can purchase and/or tolerate.
When you see someone who has a doctor (dealer) that gives them as much adderall as they want, illusions of differences between the two drugs rapidly fade. I'm talking about 100+mg a day, I've seen it happen, still have 50mg adderall pills from the person in the story.
This is a terrible comparison. Meth[amphetamine] and Adderall [amphetamine] are extremely similar. Both act as triple monoamine releasers, releasing the most norepinephrine followed by dopamine followed by serotonin.
The methyl group attached to the amine basically just helps it cross the blood brain barrier better and makes it more resistant to enzymatic destruction. This means it is a couple times more potent dose-per-dose and lasts longer.
It's nothing like the difference between methanol and ethanol, where one will kill you and the other is fine to drink. That IMO a rationalization people with ADHD make to convince themselves their prescribed amphetamines are somehow qualitatively different than big scary meth--just like the rationalization that amphetamine acts magically different in people with ADHD (it calms everyone down in low doses, it just might not provide the same working-memory deficit correcting effects as there is no deficit). In fact, in most of Europe, amphetamine itself is what you find on the streets, not meth.
I've taken substances of various schedules legally and otherwise before, and I've never heard of a doctor writing a prescription for methamphetamine. I really wonder if they have it in stock at my local pharmacy.
Look, this is what I'm driving at, you appear to have some illusions that methamphetamine is significantly different than other amphetamines, or has some higher toxicity profile, more addictive, IDK I'm trying to get you to tell me your biases.
At that point, we can go look at the clinical literature and see what the evidence is.
Yes - why, as your own source says, are amphetamines prescribed at 4,000 times the rate of methamphetamine? Is there no reason for that? Why does the medical system have such a bias?
Note that you've gone from this statement, to acknowledging that they are regularly prescribed.
> Imagining a doctor writing a script for meth is pretty amusing, and maybe if that’s not a cool enough drug, they can hand out some crack or something.
I assume in a country of 300 million people, every prescription drug is probably prescribed to someone. I’d say what I take issue with is “regularly”. I’ve known many people who have prescriptions for amphetamine, and zero who ever got a prescription for methamphetamine (though certainly some took it anyway).
The 4000:1 prescription number would seem to corroborate my impression that it is quite rare.
