ADD, ADHD Medications: Immediate Release Stimulants – Cheap and Low Compliance

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Blue Sky Thinking With ADD MedicationsImage by Tonyç via Flickr

Medication Madness

So, why do some continue to fool around with IR [Immediate Release] meds? – Money talks, – insurance money.

Looks like blue sky thinking to me…

Managed Care Creates A Significant Problem, Cost is a Problem, but IR medications then create even greater downstream challenges that often lead to treatment failure and non-compliance: Many fail because they don't take the medications consistently.

See the 7 Tips on how to better understand IR titration strategies, soon at EzineArticles.com

With the increased influence of managed care, the choices of medications for
thousands are limited to the generic [often less expensive] immediate release medications. IR medications are less than satisfactory in the first place, for reasons listed in the 7 Tips Article.

Ineffective treatment incurs greater long-term costs on many levels. Why managed care would encourage the use of less medically effective products and create
greater cost, coupled with that inferior patient care, is a challenging subject beyond the scope of this brief overview.

Clinical Implications of IR Medications

On first thought, one might guess that the IR medications would almost always be adjusted correctly, as they have been around for decades, and appear at first as more simple, less complex intervention strategies. The uniformed hope for that conclusion, partly because it appears to make common sense.

The most difficult aspect of this unhappy circumstance: IR choices with stimulant medications regularly seem to invite insufficient attention to adequate adjustment. Indeed they are often adjusted incorrectly. When the DOE for the day is not covered, the patient does not focus, cannot meet responsibilities sufficiently.

Watch for this upcoming article – should be approved soon at Ezines, …isn't Grumpy, but applies to many folks using the IR dosing strategies for stimulant meds.

cp

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4 Comments

  1. Dr Charles Parker says:
    December 9, 2008 at 10:56 AM

    Betsy,
    Thanks for your kind comments, – and, yes, to add insult to injury, the ADD/ADHD devil is also in the ‘fine distinctions’ of dosing details of “when in the day” the keys are misplaced.

    So often not appreciated, and will be covered extensively in my new book: ADD is a ‘contextual diagnosis’ based on the ‘reality and the rate of change of reality’ within a ‘given structure’…- that’s a mouthful! To simplify: it is contextual, not like the flu, not an all day experience. If the very essence of ADD/ADHD is contextual, why aren’t we thinking contextually when adjusting the meds?

    As you well know Betsy, as one of the more informed members of the medical community, we simply ‘don’t pay attention to not paying attention.’

    Time and rate of change are the unrecognized variables.

    Thanks for your kind comments,
    Chuck

  2. betsy davenport, phd says:
    December 8, 2008 at 5:03 PM

    The rampant medical inattention to the finer points of dosing are in my expereince the very ones that either make or break treatment’s success.

    In discussing with a physician here the ways a medication was helping a patient find his mislaid keys and such, but not in setting up systems for preventing the mislaying to begin with, this doctor listened carefully, and replied, “Well, you are getting into some very fine distinctions, there…” as though to say they were too fine to warrant medical intervention.

    When it comes to cognitive function, it matters whether a person can develop the routine of putting keys in a single place and not waste time and trouble on getting better at looking for them! It is more than just a convenience to be able to resume a train of thought after a brief interruption. The timing of a second dose of IR medications is crucial to that person’s day and life.

    Thanks for your work, Dr. P. As you know, I’m an avid reader-listener.

    betsy

  3. Dr Charles Parker says:
    December 6, 2008 at 6:35 AM

    Gina,
    You did catch the drift early on the Dwarf series… so many details that appear so obvious are discounted as mild or minimal when those very details make the treatment successful.

    With some managed care the treatment for those with psych conditions is: don’t use the science, just go with inconvenience, the minimum, and create a situation in which the patient has to come to the office more frequently.

    In the Tidewater area we have a company that is so ridiculous in this penury, in this poor patient care, that they met and decided that every new person on ADD meds *Had to Fail Concerta before any other drug could be written!*

    In their complete oversight they created thousands of dollars of more charges in office visits because Concerta’s DOE max is about 10 hr – on a very good day. And the ‘bewitching hour’ is over looked, each patient needs 2 scripts [another variable with compliance – one additional for those hrs between 4-8PM]. I doubt seriously they know what the bewitching hours mean to evening family life.

    Thousands of people swim downstream in their swill of inadequacy and *required insufficient* medicine, – and this for more than 1 year – with no response to reasonable phone calls. Oh hum… no biggie.

    Perhaps his is where Dopey comes in? Could draw a metaphor on Sleepy as well – they clearly don’t have a clue about what is going on in offices, in the trenches with their paid subscribers.

    Thanks Gina, appreciate your always helpful remarks, and know that we aren’t the only part of the country suffering limited, ‘mismanaged care’ companies requiring paleolithic care.
    cp

  4. Gina Pera says:
    December 5, 2008 at 1:16 PM

    Thanks for this, Dr. Parker.

    That “Blue Sky” thinking can create a lot of storm clouds — and even some lightning bolts.

    They don’t call it the Ritalin Rebound for nothing.

    I remain grateful for your continued posts on learning how to get the ADHD meds right. So many people give up after the first (or even second) try, because the side effects can feel worse than the symptoms when the stimulants aren’t properly titrated, chosen, etc.

    What about Sleepy, Dopey, Happy, and all the rest? Is this a new series? 🙂