February 26, 2020
While most people are familiar with ADHD prescription stimulants such as Adderall or Ritalin, fewer patients are knowledgeable about Vyvanse, another prescription-only amphetamine. While marketed as a safer alternative to other medications with higher potential for abuse, there are still some significant concerns about Vyvanse that you should be aware of.
Vyvanse is the brand name of the prescription medication lisdexamfetamine dimesylate. Because it is a powerful amphetamine-class drug, it is classified in the United States as a Schedule II controlled substance. Vyvanse is typically prescribed for a number of conditions, including:
When taken for legitimate reasons and as directed, Vyvanse is a safe and effective medication. Not only does it reduce the “core” symptoms of ADHD – hyperactivity, impulsivity, inattention – it also improves a number of functional outcomes, including:
In addition, in children with ADHD, Vyvanse use promotes a gain of 4.5 IQ points
Finally, lifetime ADHD therapy involving Vyvanse that commences during childhood has been found to reduce the chances of the patient developing an addictive disorder as an adult.
Although Vyvanse has legitimate medical uses, it is also diverted for recreational purposes and for supposed cognitive and athletic performance enhancement.
The problem arises when Vyvanse is misused in non-medically, in a manner not recommended by the prescribing physician. In fact, it has become common practice among Vyvanse abusers to fake the symptoms of ADHD in order to obtain a fraudulent prescription.
According to the Centers for Disease Control and Prevention, ADHD is a very prevalent condition in the United States, affecting 11 % of American children between the ages of 4 and 17, and 8% of adults aged 18-44. Moreover, ADHD rates are rising sharply – in 1997, less than 7% of children were affected.
Because of this, the use of Vyvanse and other prescription stimulants is also rising. In 1990, roughly 600,000 US children were prescribed stimulants as treatment for their ADHD. However, a generation later, in 2013, the number of children being given prescription stimulants had ballooned to 3.5 million.
While far behind industry-leader Adderall, Vyvanse is growing in popularity. For example, in 2013, Vyvanse accounted for approximately $1.25 billion in sales for Shire, its parent company. But it is estimated that for 2017, spiked to $2.1 billion.
Of course, Vyvanse draws comparisons with better-known ADHD medications like Adderall.
Vyvanse versus Adderall:
Compared to Adderall, Ritalin, Concerta, and especially their generics, Vyvanse is far more expensive. According to Drugs.com, here are the cash prices for 100 tablets of each medication:
Right now, there are no generic formulations of Vyvanse, and their patent does not expire until 2023. However, several companies have already applied for permission to release generic versions of lisdexamfetamine dimesylate of upon that expiration:
Vyvanse comes in two different formulations – capsules or chewable tablets, and seven dosages – 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, and 70 mg. The chewable tablets, typically prescribed for children, do not come in the 70 mg dosage.
Vyvanse is taken once a day, and effects are felt within two hours. The duration of effects can be between 12 and 14 hours.
Even when taken exactly as directed, Vyvanse, as an amphetamine, can trigger a number of adverse physical and psychological side effects, including:
Although the abuse potential for Vyvanse is less than that of other ADHD medications, it can still nonetheless be abused or misused non-medically. At sufficiently high doses, Vyvanse can increase the user’s energy and create a euphoric feeling of well-being.
All prescription ADHD stimulants are popular as supposed study aids. Misuse is highest among high school and college students, who take Vyvanse illicitly for its supposed cognition-enhancing effects.
Vyvanse is also misused by athletes, because it increases:
Use by athletes is somewhat risky, however, because amphetamines are banned by the anti-doping commissions of organized sports at every level. Also, at higher doses, they can impair athletic performance by elevating body temperature and accelerating muscle breakdown.
One of the biggest factors in the development of Vyvanse dependence and addiction is how rapidly a user can become amphetamine-tolerant. Needing higher doses to feel Vyvanse’s effects, the user soon becomes dependent on the drug, and will experience painful withdrawal symptoms whenever it is not available.
Almost 90% of chronic, heavy abusers will experience withdrawal symptoms within 24 hours of discontinuation. These symptoms can last up to four weeks, with the biggest “crash” occurring within the first week. While not particularly dangerous, Vyvanse withdrawal can be profoundly uncomfortable, and may push the person back into resumed abuse:
For those people who DO legitimately struggle with ADHD, it’s important to consider that, across-the-board, they have higher rates of substance use and dependence:
Overall, people with ADHD have a risk of developing a substance use disorder that is two-and-a-half times greater than those without the condition.
Why is this the case?
First, many people with emotional disorders attempt to self-medicate to ease the symptoms of their condition. This is especially true with ADHD sufferers.
Second, people with ADHD often have impaired executive functioning and exhibit poor judgment, which can lead to substance experimentation and eventually, regular use.
Third, some researchers believe that there is a biological connection between ADHD and substance abuse. In other words, there may be a shared genetic vulnerability between the disorders.
It is important to keep each of these factors in mind with ADHD patients who are prescribed Vyvanse, because of the specific habit-forming properties of their medication. If a person habitually self-medicates with higher-than-prescribed dosages, they can quickly develop a tolerance that soon progresses to dependence and addiction.
As with any amphetamine, people who use Vyvanse can develop a tolrance– a reduction in effectiveness of the drug, meaning the person has to take ever-increasing dosages in order to realize the same effects. Drug-tolerant users have been known to take up to 100 times the maximum recommended daily dose.
A Vyvanse overdose is a medical emergency. Severe overdose symptoms include:
For other habit-forming substances, there are medications that can help ease cravings and alleviate withdrawal symptoms, but there are no such pharmacological options to support recovery from Vyvanse addiction.
The lack of an effective medication makes the other steps in the rehab process that much more important. Successful recovery will require time and effort as the addiction is addressed on multiple levels:
Vyvanse is an approved first-line treatment for ADHD and binge-eating disorder. As a delayed-release medication, it has a lower abuse potential than other prescription stimulants, but “lower” does not mean that it cannot be abused recreationally.
On the contrary, amphetamine-based medications rapidly and directly affect the brain. And because Vyvanse tolerance and dependence can develop so quickly, anyone prescribed this drug needs to have a frank discussion with their doctor about any factors that could increase the risk of misuse.
And if any potential problems are identified, then alternate medications and other possible interventions and strategies should be explored
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