Thread by @Deezovariez

I need ADHDers to understand that the same forces (CDC, DEA) which made it nearly impossible to be prescribed opioids for chronic pain (unless you're sufficiently rich & white), is now coming after your #ADHD medication

The DEA will not respond to the Adderall shortage by easing restrictions on production. They will do it by eliminating treatment for ~undesirable~ patients, thus saving first line #ADHD treatment for the white & wealthy. Legal drugs for them, the dangerous illicit market for you

This has already been happening, just in less well-known, codified ways. ADHD is already tremendously underdiagnosed & under-treated for women, Black, Indigenous, & Latine people, poor people. The NarxCare algorithm has already denied care to poor & marginalized people

But the creation of "guidelines" will be the death knell- just as it was for chronic pain patients. Guidelines will take the suggestion to not treat ~undesirable~ patients and turn it into a mandate. If doctors violate that mandate, they could lose their license & go to prison

CDC & DEA will claim that restricting stimulant medication is the only way to keep people safe from the scourge of addiction & overdose death. They are lying. For people with ADHD, treatment w safer, legal, well-regulated stimulants significantly *lowers* risk of substance use

We're about a decade into the crackdown on prescription opioids. You tell me- are people "safer" now? Have overdose deaths decreased? Is the constantly-climbing DEA budget saving lives?

And that bar graph is just overdose deaths. We don't have data on the suicides of chronic pain patients (not yet anyways, @StefanKertesz is working on it), but anecdotally- the online chronic pain community lives with the spectre of suicide. It is ever-present & traumatizing

We know that giving an ADHD person first line medication- undeniably stimulants- does an excellent job of alleviating depression & anxiety in many ADHDers, and lowers our risk of misusing substances and other generally "risky" behavior.

They do not care. I promise you that.

I can tell you from personal experience that going undiagnosed for 32 years and still not being treated for ADHD at 35 years old has been absolutely devastating for me- personally, financially, mentally, in every conceivable way. Depression over that catastrophe is unbearable

In a matter of years we went from "pain negatively affects your body & mind & pain management is a human right" to "actually opioids shouldn't be used for chronic pain, opioids don't do anything for pain, no wait actually they make pain worse" based on... tenuous data (at best)

If guidelines for the treatment of adults w ADHD follows the same arc as the 2016 CDC Opioid Guidelines, here are some lies to anticipate:
ADHD only affects kids, adults grow out of it

Stimulants are not the most effective treatment for ADHD

Too many ADHD meds = more OD death

For the last decade, a group of doctors (largely addiction specialists but some pain management doctors as well) have made very lucrative arrangements to testify against opioid manufacturers in state lawsuits, promote non-opioid therapies/programs, lecture, & receive grants

Frankly- the lawsuits against opioid manufacturers are winding down, and these people need a new grift. They measure success solely in the reduction of prescriptions, but opioid prescribing is already at a 20-year low. Stimulants are the next natural target.

I skip around a lot (untreated #ADHD) but on the concept of "undesirables-" This isn't the official terminology, they refer to us as "high risk" patients. Due to individual & systemic bias, being poor, a woman, and/or Black, Indigenous, or Latine effectively makes you "high risk"

Just in case you make it past discrimination in a doctor's office, in most states in the US doctors are legally required or STRONGLY encouraged to check a patient's NarxScore before prescribing a controlled substance- and you aren't entitled to know where that score comes from

*Everyone who follows me collectively groans because I'm talking about NarxCare again*

But what is NarxCare? It's a predictive risk algorithm. It uses- at minimum- your healthcare records & criminal data (the rest of the sources are concealed) and with those decontextualized data points it spits out an Overdose Risk Score for you. You do not get to see your report.

NarxCare is a predictive risk algorithm, just like the algorithms that are regularly found to exhibit race, class, & gender bias in bail, parole, prisons, even child welfare cases. It removes the ~burden~ of discrimination on the provider, isolating it to a number on a monitor

Who gets flagged as "high risk" under an algorithm that was trained off of materials developed in response to The Opioid Crisis (TM)? Virtually anyone w a mental health diagnosis, but particularly people w bipolar, borderline personality disorder, or so-called "conduct" disorders

For poor & marginalized people who are #ADHD, & especially for #AuDHD people (like me), we usually either go undiagnosed well into adulthood, or get misdiagnosed young, usually when we start breaking down over how difficult being alive without support is

A stunning number of ADHDers who are women or were once perceived as girls/women, talk about being misdiagnosed. Often for decades, while our lives fall apart. The most common misdiagnoses for this general group of ADHDers are Bipolar Disorder & Borderline Personality Disorder

But wait! It gets worse! For Black people (of all genders) especially, as well as for Indigenous and/or Latine people, there is a different common misdiagnosis- a "conduct disorder." Usually "Oppositional Defiant Disorder."

Yes I'm using quotes bc conduct disorders are bullshit

If you've got a history of being misdiagnosed & taking medications for Bipolar Disorder, Borderline Personality Disorder, Bullshit Racist Conduct Disorder, even if you eventually get that removed (or worse, it's comorbid w your ADHD) NarxCare knows, & it will flag you for it

Actually, I'm wrong- diagnosis of bipolar disorder is also being weaponized against Black people specifically. I went searching for the statistic that over the course of a decade bipolar diagnosis in kids rose 500% but got confronted with my own assumptions instead. My apologies!

Black kids in the US are 69% less likely to receive an ADHD diagnosis than their white peers, Latine kids are 50% less likely to get an ADHD dx. Black & Latine males are *significantly* more likely to have a conduct disorder diagnosis than their peers. Bias in medicine is a fact.

(Source: ncbi.nlm.nih.gov/pmc/articles/P…)

Now, to be clear, poor & marginalized people *already* face nearly insurmountable barriers to ADHD diagnosis and treatment under the current system of partial prohibition & healthcare surveillance. I'm one of them. This is not a "what could happen" scenario- this IS happening

Those of use stuck in the wasteland of untreated #ADHD already know how difficult it is to function in any way in this society. Doctors will conform to new guidelines. Will you make the cut? Will you be seen as white enough, wealthy enough, respectable enough to deserve care?

We're hearing such intense rhetoric against ADHD diagnosis & meds specifically bc poor & marginalized people have- as adults, on our own- identified our ADHD & sought help. The pandemic led to a loosening of telehealth restrictions, time off, & stimulus payment- lowering barriers

Media reports it as a scandal that ADHD Rx rose 10% in the first year of the pandemic (the implication being that these are fakers who just want drugs). Legacy middle class white kids w Rx Adderall will prolly be fine. But the newcomers (poor & marginalized adults) will be purged

One lesson the chronic pain community had to learn the hard way is: every effort will be made to split up the #ADHD community. Patients who are deemed worthy of meds are told that they have to do all this extra work bc of fakers. If you lose meds you'll be told to blame fakers

If you can't get meds you'll be told to blame "fakers," but here's the thing- topeople who make a living by defining new restrictions for controlled substances, we are all fakers. You only avoid that category with wealth & whiteness. Turning on "fakers" is turning on yourself

In some corners of the chronic pain community, people w substance use disorder are regarded with hatred. We were told to blame ~those people~ for our pain. I had to unlearn that. I'm a socialist. I won't blame other vulnerable people, but the system that sets us up to be enemies

The vast majority of people who use substances, legally or illegally, medically or non-medically, do not develop substance use disorder. Restricting access to safer, regulated drugs doesn't protect anyone. Even if they don't have ADHD, they're safer getting adderall from a doctor

If #ADHD-ers have any hope of reversing the tide, we HAVE to work in solidarity with chronic pain patients, people who use drugs, and harm reductionists. If we try to isolate and fight new restrictions on our own, only the whitest & wealthiest ADHDers will survive it

Figuring out my ADHD & autism and getting diagnosed was a pivotal moment in my life. I wish it had happened at 12 years old instead of 32 years old, because the damage of misdiagnosis has haunted me my entire life. I'm statistically likely to die 13 years earlier than my peers

We are human beings. We have lives, families, an abundance of enthusiasm & interest in the world. But we are constantly dragged down into precarity, into shame & guilt over issues we have no power to individually change. But we have power together. I have to believe in that