This is because pharmacology is a shell game, where there is a constant pipeline of new chemicals being rotated in as soon as they're "recognized as safe". That is because people start to notice the adverse, toxic effects of the "old and busted" chemicals, such as Thalidomide or Phen-Fen, aren't such the "miracle drugs" they were cracked up to be, so there needs to be a constant stream of new stuff to replace it. They simply need to approve drugs a bit faster than attorneys can file class-action lawsuits.
Another effect is that the "new stuff" is a weak synthetic facsimile of whatever the previous drug generations were, and eventually you end up with 100% fake treatments, often doing the opposite, exacerbating and magnifying the very symptoms they're prescribed for, or damaging the target organs/glands, and shutting them down.
"Fail first" or "step therapy" policies by insurance carriers will aid and abet this behavior, as the prescribers are forced to begin with inexpensive and ineffective (or harmful) treatments before they can even propose a treatment that is deemed efficacious.
So, yes, my comment about people high on amphetamines was relatively tongue-in-cheek, because physicians are seldom incentivized to get people high these days: they're incentivized to push the new hotness wonder-drugs that people haven't figured out are just as horrible as the old ones.
Nope. The two most common non-amphetamine ADHD drugs, methylphenidate and atomoxetine, are both now old enough that they’re available in generic form, and methylphenidate is cheap enough that step therapy is not routinely required before insurers cover it. Even one of the pretty new and therapeutically effective long-release amphetamines, Vyvanse/Elvanse, is now available as a generic as of (I think) summer 2023. So are most of the other amphetamines.
You’re right in general about how much of the pharma industry prefers to operate, but wrong about what’s true in the specific context of ADHD treatment, and also wrong (even if your remark was only tongue-in-cheek) about whether people with ADHD get high when they do take an amphetamine as prescribed.
That last misconception is actually quite harmful, whether or not you were joking. It’s a perverse fact that most of the obstacles which state and federal legislators, state and federal regulators, major pharmacy chains, and pharmacists put in the way of smooth access to most ADHD medications - primarily as part of the war on drugs - are uniquely hard to handle and overcome for people with ADHD, due to the types of life struggles that ADHD causes in particular.
The widespread stereotype of people with ADHD as drug seekers looking to get high, at least in much of the US, makes appropriate policy outcomes hard to achieve and hard to experience in practice. The benefit of medicines to people with ADHD is no less legitimate than the benefit of Ozempic or insulin to people with diabetes. And nobody with ADHD gets high from therapeutic doses of ADHD medicines.
Anyone who does get high from such doses doesn’t actually have ADHD, and so either they got the prescription from a doctor guilty of diagnostic medical malpractice (or a doctor complicit in a false diagnosis/prescription) or they lied to the doctor in a fraudulent way when undergoing the diagnostic process. Those are worth punishing, but not at the expense of making it unreasonably difficult for the medicines to be accessed by the very same population for which they are quite legitimately approved and prescribed.
https://en.wikipedia.org/wiki/Fenfluramine/phentermine
Another effect is that the "new stuff" is a weak synthetic facsimile of whatever the previous drug generations were, and eventually you end up with 100% fake treatments, often doing the opposite, exacerbating and magnifying the very symptoms they're prescribed for, or damaging the target organs/glands, and shutting them down.
"Fail first" or "step therapy" policies by insurance carriers will aid and abet this behavior, as the prescribers are forced to begin with inexpensive and ineffective (or harmful) treatments before they can even propose a treatment that is deemed efficacious.
https://en.wikipedia.org/wiki/Step_therapy
So, yes, my comment about people high on amphetamines was relatively tongue-in-cheek, because physicians are seldom incentivized to get people high these days: they're incentivized to push the new hotness wonder-drugs that people haven't figured out are just as horrible as the old ones.