Regarding generic equivalents - let me give a little history lesson:
For Methylphenidate based medications, Ritalin, Ritalin LA, and Concerta all have the same active ingredient. However patients were willing to pay extra for Concerta due to it having the OROS delivery system which delivers the medication over an unusually long period of time of 12 hours in a very steady way.
However in the US, the FDA allows medications which deliver within 80% to 125% of the same medication to qualify as a generic. A bunch of generics for concerta which did NOT use the OROS delivery method but instead used cheaper inferior methods which did not deliver medication as steadily or for as long were released simply because they were within that 80% to 125% window. In fact these generics were more similar to Ritalin LA than they were Concerta, so essentially the FDA allowed essentially a different drug to be substituted for Concerta when the ENTIRE POINT of Concerta for many patients was that it gave a longer lasting steadier dosage than Ritalin LA. If a patient didn't need this advantage, they could just take Ritalin LA instead. This was used as a pretence to deny insurance coverage for Concerta because a generic existed and caused many insured patients to pay thousands of dollars out of pocket for the real deal which they never saw again. These generics were scams which hurt patients quality of life and the medical system was complicit in hurting patients while financially benefiting these fraudsters since only having to pay for fake medicine instead of real medicine saved them money. Nobody besides patients were punished.
The problems with Concerta generics happened around the same time as the problems with Wellbutrin generics, problems which the FDA ALSO denied for years before backpedalling. The whole "generics are the same as the brand name" dogma is not actually true for all medications, and it's ADHD patients historically who were one of the groups of patients who found this out for themselves.
So if people suspect there is a problem with their Adderall generics, I am VERY inclined to believe them, because we know that patients using similar drugs have shown extreme sensitivity to differences in generic equivalents in the past, and we know the FDA has approved "Generic equivalents" that were anything but repeatedly in the past.
If you are getting ADHD medications, you can request your doctor write "no substitutions" and a specific brand on your prescription. If you are having coverage denied for either the brand name or the generic medication of the brand name (the exact same medication but with a different name and lower price, rather than being an equivalent) you CAN often get your doctor to help you lobby your insurer to get a specific brand covered by claiming medical need.
>This means that, theoretically, obtaining a generic form of Adderall from a different manufacturer could alter how you feel while on the medication. However, the differences between generics are so small that an overwhelming majority of patients wouldn’t feel any change from their previous medication. “It’s not supposed to have drastic differences,” Dr. Dube said.
What an absolutely fucking ignorant assertion given the history of ADHD patients being noted for their sensitivity to small differences between brand name medications and generic equivalents. What data did he use to come to the conclusion the "overwhelming majority" wouldn't feel any change and is he talking about the ADHD patient population or the general patient population? If he means the former he's wrong, if he means the latter he's being obtuse and misleading.
> What data did he use to come to the conclusion the "overwhelming majority" wouldn't feel any change and is he talking about the ADHD patient population or the general patient population?
This was my thought as well. Im very sensitive to manufacturers and spent months bugging my pharmacist to tell me which "brand" they had in stock so I could pick the one with least side-effects. Even though they had a note in my file they would just give me whatever they felt like and told me there was no difference.
It took a different pharmacist who was also sensitive to understand my problem - to the point she chased me down this month after paying to tell me that it was a new manufacturer she hadn't seen filled for me and wanted to double check I wanted it before leaving the store. With the shortage I didnt care & was why she filled it before checking since it was all they had and would run out if she waited. And, it's not great, it's weaker which causes me to get tired (small doses put me to sleep), and starts to dissolve instantly so it will sometimes stick if I dont drink fast enough.
I think that is one of the biggest problems. If people think they should all work the same and then get worse side effects they think its a fake, but it's probably just a different manufacturer that they have no idea to even check.
For those that do, they dont seem to consider they are sensitive to the change. The best manufacturer for me is Camber, it's the only one that has no side-effects and "just works". The first few days I thought it was a sugar pill until I realized just how much I got done without even noticing. But do a quick search and people are outraged at getting switched to them and trying to get the FDA to revoke it.
> and it's ADHD patients historically who were one of the groups of patients who found this out for themselves.
I guess the things that work with immediate changes are going up be easier to spot. But even then you don't often know the expected result with (for example) pain killers. On the other hand, if ritalin wouldn't work as usual, it would be really obvious to me within a couple hours.
I have the same issues with my birth control. I thought I was becoming a conspiracy theorist, because it was entirely undocumented. But I know what I feel.
I took the same name brand pill since I was 13, then I moved to the US at 21, had to switch to bunch of generics, they never worked the same (I mean I didn't get pregnant) but I'd get terrible migraines and other side effects I never got from name brand
This is an incredibly insightful comment. It’s a bit insane that the scope of the drug does not include it’s delivery system. Timing is everything for psychiatric medicine but also I could easily see it being important for things like antibiotics or pain medication.
For Methylphenidate based medications, Ritalin, Ritalin LA, and Concerta all have the same active ingredient. However patients were willing to pay extra for Concerta due to it having the OROS delivery system which delivers the medication over an unusually long period of time of 12 hours in a very steady way.
However in the US, the FDA allows medications which deliver within 80% to 125% of the same medication to qualify as a generic. A bunch of generics for concerta which did NOT use the OROS delivery method but instead used cheaper inferior methods which did not deliver medication as steadily or for as long were released simply because they were within that 80% to 125% window. In fact these generics were more similar to Ritalin LA than they were Concerta, so essentially the FDA allowed essentially a different drug to be substituted for Concerta when the ENTIRE POINT of Concerta for many patients was that it gave a longer lasting steadier dosage than Ritalin LA. If a patient didn't need this advantage, they could just take Ritalin LA instead. This was used as a pretence to deny insurance coverage for Concerta because a generic existed and caused many insured patients to pay thousands of dollars out of pocket for the real deal which they never saw again. These generics were scams which hurt patients quality of life and the medical system was complicit in hurting patients while financially benefiting these fraudsters since only having to pay for fake medicine instead of real medicine saved them money. Nobody besides patients were punished.
This was well known and well documented within ADHD circles and after some years led to two generics being decertified. https://chadd.org/attention-article/exactly-like-brand/ https://www.goodrx.com/concerta/certain-generics-are-no-long...
The problems with Concerta generics happened around the same time as the problems with Wellbutrin generics, problems which the FDA ALSO denied for years before backpedalling. The whole "generics are the same as the brand name" dogma is not actually true for all medications, and it's ADHD patients historically who were one of the groups of patients who found this out for themselves.
So if people suspect there is a problem with their Adderall generics, I am VERY inclined to believe them, because we know that patients using similar drugs have shown extreme sensitivity to differences in generic equivalents in the past, and we know the FDA has approved "Generic equivalents" that were anything but repeatedly in the past.
If you are getting ADHD medications, you can request your doctor write "no substitutions" and a specific brand on your prescription. If you are having coverage denied for either the brand name or the generic medication of the brand name (the exact same medication but with a different name and lower price, rather than being an equivalent) you CAN often get your doctor to help you lobby your insurer to get a specific brand covered by claiming medical need.
>This means that, theoretically, obtaining a generic form of Adderall from a different manufacturer could alter how you feel while on the medication. However, the differences between generics are so small that an overwhelming majority of patients wouldn’t feel any change from their previous medication. “It’s not supposed to have drastic differences,” Dr. Dube said.
What an absolutely fucking ignorant assertion given the history of ADHD patients being noted for their sensitivity to small differences between brand name medications and generic equivalents. What data did he use to come to the conclusion the "overwhelming majority" wouldn't feel any change and is he talking about the ADHD patient population or the general patient population? If he means the former he's wrong, if he means the latter he's being obtuse and misleading.