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PostPosted: Fri Mar 16, 2018 5:54 pm 
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During my last session with my counselor I brought up possibly adding the drug Vyvanse to treat my problems with lack of attention and Binge Eating Disorder. I've gained a almost 90 pounds in less than a year and despite all of my efforts, I still can't stop feeling hungry all the time. I have been dealing with extreme weight fluctuations my entire life, spending most of that time overweight. Add to that a complete lack of ability to focus or concentrate. I'm unable to finish things I start (that is if I ever start to begin with), or keep dates and times organized. It's really affecting my ability to take care of my father.

This medication was suggested to me by a friend who had ADHD. They told me that it can be helpful for people like me that are suffering from an eating disorder and problems with attention. But since it's a type of prescription amphetamine, I didn't think it would ever be a possibility for me considering my history with opioid dependency. I have an appointment with my psych meds provider next week to talk about it. Have any of you had any experience taking medication for ADD/ADHD or Binge Eating Disorder while you were on Subs? Was it effective or were there side effects or complications?

Even if it could be prescribed, I have a feeling my primary care doctor, the one treating me with Subs for opioid dependency wouldn't like it. He's very conservative with medications unless there is a real need for them. Honestly this is one of those times when I feel there is a real need. I'm not trying to get a high or replace one addiction for another, but I desperately need medical help. All of this extra weight is causing a lot of chronic pain in my back and on the joints in my legs. I've been going to physical therapy for a while now to address the pain, but I still have a problem with the eating and appetite. I feel disgusting and it makes me not want to leave the house. Then that feeling makes me want to eat even more. It's getting out of control.

I would appreciate any thoughts, comments or advise. You can be as blunt as you'd like. Thank you!!

- OpenMind

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PostPosted: Sat Mar 17, 2018 2:02 am 
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Amber used to be a mod here. She has fairly significant ADHD and is on suboxone for opioid addiction. I know that she has been prescribed Vyvanse and that it helps her with her ADHD quite a bit. I hope your suboxone doctor can realize that you just need some help. If that requires that he speak with your counselor or psychiatrist, then he should be willing to do that. You do have a psychiatrist, yes? Because if you don't you should. But I think you said you have one. Forgive me for not looking back at your other thread.

I think it's possible that your meds need revamped if the addition of Vyvanse doesn't help. I don't know about whether it would show up on a UA as an amphetamine. I just hope that your sub doctor can be a little bit flexible since you are really suffering through some very difficult times. I do also wonder if instead of having a doctor for sub and a doctor for other psych meds, you should be prescribed everything from a psychiatrist. It seems like there should be one person that can be responsible for helping you find the best medications and also be able to provide some insight into the things that are affecting you.

I don't know if this question is really off base, but have you considered getting a CNA and being able to be paid by the state for caring for your father? I know a couple people who have done that while caring for their ailing relatives, but I don't know if doing that would be feasible for you. I do think that getting a paycheck for the way you help your dad would be more motivating than doing all of the work for no pay. It's an idea anyway.

I don't know the answers about weight, but I do know from my mom's experience that losing a bunch of weight usually precedes putting it back on and then some. Dieting screws up our metabolism so much. I think that what you feel, though, is really out of control. You have some compulsions driving you that you don't know how to control. I'm wondering if you would do better in a really structured environment, like an inpatient facility. Except that I know you have to take care of your father. Since you are stuck in this area, I think the best you can do is ask your doctors (or get one psychiatrist) to help with your medications.

I'm sorry that I don't have a lot of insight to give. You know I'm pulling for you though.

Amy

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PostPosted: Thu Mar 22, 2018 9:51 pm 
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Thank you for your reply Amy. I had my appointment today and my counselor really thought this might be helpful for me. But I should have known better. I didn't even have a chance. The med provider told me immediately that this medicine was "off the table" because I was an addict. I tried to state my case as to why this could be beneficial and how I felt so very desperate for help other than more talk therapy. I've just about had enough of talking.

After breaking down in his office, he called a facility that treats younger kids and teenagers and asked them to give me a call if they had any resources. Then he wrote a prescription for Wellbutrin. I've taken it before and I didn't get much out of it but he said to take it anyway. It was all he could offer me. Later in the afternoon that place called me. The nearest location they have is about 3 hours away in the next state, so that won't work.

It looks like I'm out of options. It's been a long time since I've felt this defeated. I have one doctor that's in perfect health and tells me to just eat less and exercise more, and another perfect-looking doctor who can't see past my addiction, even if it's in remission. I feel terrible because I stopped by a store and bought some maple bars on the way home. Now my stomach and head hurt from the volume of food and the excess sugar overload. God, I feel disgusting.

I wish doctors would offer me more options than dieting and talking to a counselor. Neither have worked over the last year and I keep gaining weight which makes me want to eat more. It's a terrible cycle. Sorry for being so negative. I just wanted to stop by and let out some emotion before it causes me to blow up. My head aches terribly... I'm going to bed now. I'll be back tomorrow. Thank you.

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PostPosted: Thu Mar 22, 2018 10:51 pm 
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I hope you keep trying, and try to avoid getting too frustrated.

Vyvanse consists of amphetamine, the same medication that makes up Adderall, bound to lysine, which is an amino acid common in things we eat. The large, combination molecule is poorly absorbed when 'snorted', and inactive at sites where amphetamine acts.

In the bloodstream the bond between amphetamine and lysine is broken, creating amphetamine. From your body's perspective, it is the same molecule that would be in the bloodstream if you took Adderall. But the need for that activation makes Vyvanse less addictive. It really cannot be used other than orally, limiting the reward of the drug. And the dose is spread across 14-24 hours, whereas people who abuse Adderall or amphetamine take the same or larger amounts over span of a few minutes. Even if Vyvanse is dissolved and injected, the onset is almost the same as taking it orally.

As most readers here know, most people that like opioids do not like 'uppers'. Doctors do tend to act like your doctor, but SOME are willing to provide stimulants to people with addictions after appropriate informed consent. There are even studies showing that opioid addicts who have ADD, who are treated with amphetamine, do better than those with untreated ADD.

The weight issue is complicated by laws and guidelines regulating weight drugs. In my state, it is not legal to use schedule II stimulants like amphetamine for weight loss. They are used for other conditions, including ADD and less often major depressive disorder. And Vyvanse was approved last year for treatment of binge eating disorder. Treating binge eating disorder usually also results in weight loss. I have had a couple patients who struggled with over-eating who did very well on Vyvanse. One in particular had a major life change. She had been through gastric bypass, and was still unable to walk any distance and was very depressed. Vyvanse boosted the antidepressant and removed the binge eating, and she lost over 100 lbs over about a year. Now she goes on a couple cruises each year with her daughter.

I realize I sound like a pharmaceutical pitchman... I should add that every now and then I have a patient who CAN'T control amphetamine in any form, who runs out early. I also should add that behavioral approaches, like increasing activity and changing diet and eating habits are more useful in most people. But some people really need a head start, seeing a bit of change that then increases their motivation.

If you have medicaid or insurance that covers office visits, keep looking. A psychiatrist is MUCH more likely to know how amphetamines work and have a comfort level prescribing them than a primary care doctor. One last thing-- realize that only half of the weight of Vyvanse is amphetamine, and the other half is lysine. So 30 mg of Vyvanse is equal to only about 13 mg of amphetamine. Many docs do not know that, and don't know that the largest dose of Vyvanse, 70 mg, was the dose approved for treating ADD in children up to age 14. When the drug got approval for treating adults several years later, the dose recommendation was not changed. Many adults are treated for ADD using up to 60 mg of Adderall per day. It would take 140 mg of Vyvanse to equal that amount of amphetamine. Again, many doctors don't know that, so if you ask for two doses you will likely be seen as too eager!

Don't give up!


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PostPosted: Sun Mar 25, 2018 4:23 pm 
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I recommend a new psychiatrist!!! I know it's a pain in the butt to go through finding one, etc. But please consider doing it! Even if you have to pay out of pocket I think it would be worth it. Where do you live again? The NW? Amber is in Astoria OR. If it's close enough, maybe we could get her doctor's info.

Amy

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PostPosted: Thu Apr 12, 2018 5:47 am 
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Thank you for the replies and for the support. I decided to not give up and had an open and honest conversation with my primary care doctor, the one that's prescribing my buprenorphine. I told him about the other provider that's managing my psych meds and how he viewed me as an addict and was unwilling to treat my eating disorder with anything other than Wellbutrin. I couldn't believe it... my doctor actually agreed that we needed to be more proactive in treating my condition. He could tell that I was really suffering and it was taking a toll on my physical and mental health.

He told me that I had proved to him that I could take the medicine responsibly and not abuse it. I have passed all of my UA's and have followed all of his instructions to the letter since I first started seeing him for treatment. I had earned his trust and respect and that made me feel really good about myself. So he wrote a prescription for Vyvanse and I quickly took it to the pharmacy. And that's when I ran into my first problem.

They told me they couldn't fill the order because my insurance wouldn't cover it. There was no way I could pay for it myself since it was almost $380 dollars for 30 capsules. That's absolutely ridiculous!! I can't believe the pharmaceutical companies can get away with those kinds of costs. So they told me that my doctor would have to fill out a "prior authorization" and that would take at least two weeks. So I called my doctor back and told the nurse that I wanted to start treatment right away instead of waiting that long.

I asked if I could get a script for something cheaper. He was really nice about it and prescribed the lowest dose of Adderall XR. I took that to get filled and the pharmacy told me the same thing. Ahh I was getting frustrated. I ended up going home and got on my computer. I went to GoodRX.com and got a major discount coupon to take back to the pharmacy. It cost me $67 with the coupon but at that point I was determined to walk out of there with my medicine. It really hurt my wallet but it was just something I had to do for myself.

Today was the first day trying it out. To be honest I'm not very impressed with it's effectiveness. They're only 5mg capsules and they actually made me feel slightly sedated. I've been able to concentrate and focus a little more than usual but I still feel the compulsion to binge. I'll give it an honest try over the next few days but I may need an increase in the dosage. In the meantime, I'm hoping that my doctor will take care of the prior authorization for the Vyvanse because he thought that would be more appropriate for me. I trust his decision and will do whatever he asks me to do so I can get better.

I know I've written quite a bit here and I appreciate anyone who has read this far. It's after 2:30 in the morning and I was feeling kind of lonely. It helps to come here and type what I'm feeling. I feel safe here. Anyway, I should try to get some rest. Thanks again you guys!!

- OpenMind

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PostPosted: Thu Apr 12, 2018 2:46 pm 
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J, prior authorizations are the bane of my existence. I hate to sound that dramatic, but I have had so many problems with this! Most often I end up crying and speaking angrily to the latest "customer service" person!

Let me give you some tips and I think that these are pretty universal.

1. Be persistent!! Don't give up because they want you to give up!!!

2. Ask the customer service person for the direct number to the prior authorization department, so that you can give your doctor's office the number. Ask your office to call and tell the prior auth. people that they need to expedite their decision!

3. Try to speak with the supervisor of the customer service person. Try to escalate the question. For my RX company, I specifically needed to get the phone number for the correct department (prior auth department), tell my doctor that he would have to call it, instead of faxing it in. And I had to learn the word for my doctor to say on the phone, which is expedite. I kid you not! It took me days and several calls to figure out EXACTLY what to do and say. It's like they have a secret code and you have to crack the code in order to get real help!

4. Keep asking for a higher level of person to talk to. Keep asking what to specifically say to get the prior authorization decision more quickly.

When in doubt, go back to #1!

Good luck!!

Amy

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PostPosted: Thu Apr 12, 2018 5:34 pm 
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I envision talking to Bob Parr's supervisor from the 'Incredibles' whenever I have to talk to an insurance company. Their responsibility is to the board and the stockholders, not the policy holders. Insert sarcasm emoji. Amy, the person who gave out the code word 'expedite' was probably fired.

http://4.bp.blogspot.com/-39MAfW8lEcM/V ... dible.jpeg


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PostPosted: Fri Apr 13, 2018 12:23 am 
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Lol!! So true! I'd say no, they did their job. They had me bouncing around like a pinball! Maybe they start a clock the first time you call to try to get help and at 48 hours has to go by before anyone tells you something useful.

I would love to be a fly on the wall for their customer service trainings!

Amy

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