HELP! Frustration w/Doc & Meds | ADHD Information

The walmart thing is only for specific meds on their list...there are several (300?), but none of them is for ADHD....not a stimulant in the list!  Tenex/guanfacine that is often used to augment the stimulant meds (and sometimes alone for the primarily hyperactive type) is on the list in the 1mg size...so that is one good thing...I'm a 43 YO male who has had a history of opiate addiction. I sought treatment for my addiction in 1997-98, and I have been on methadone 125mg/day for nearly ten years. My track record with the opioid treatment clinic is nearly perfect-I have not taken any street drugs for at least 8 years. I can't even remember the last time I "did drugs" recreationally. I'm past it psychologically, socially and attitudinally.
My life has been stable for these past ten years, I had been working full time, attending some college, and generally living life as a normal, drug-free person would. But something wasn't quite right. I didn't focus well at school, nor did I advance as fast as I think I should've in my career. I've been like this all my life.

About 6-7 years ago, I began to learn that adults could be diagnosed with ADHD, and the symptoms matched me to a tee. Recently I saw a psychologist who did indeed diagnose me with 'moderately severe ADD-inattentive type'. He recommended medication, with "breaks" to help prevent tolerance.

To actually get a prescription, I had to go to my Primary Care Physician, who I hardly knew. I had only got him randomly a couple months ago because of an unrelated illness. Also, I did not (and still do not) have insurance.
He agreed to put me on Adderall XR, but made it clear that I was under his watchful eye - he would cut me off if he suspected I was abusing it. Naturally, I agreed. I have not "abused" drugs for the better part of a decade.
I asked him if there might be a generic equivalent, and he replied no, there wasn't.
I went to the pharmacy, and I almost had a heart attack when the bill was over 175 dollars cash for 30 15mg capsules. I have never had a prescription that expensive, and since I am also currently unemployed (probably due to ADHD) I certainly could not afford it, no matter how much it might improve my life.
Luckily, I found a coupon from Shire, (the makers of Adderall) on the internet, which was for a free month's supply of Adderall XR. That took care of the first month. The Adderall was fine, it seemed to improve my symptoms a little bit without making me speedy or euphoric.
But, I thought there must be some cheaper alternative to Adderall XR, so I researched its ingredients and of course discovered that Adderall is basically just  dextroamphetamine, but with supposedly less potential for abuse because of its formulation, or at least that's what Shire claims. This is why they can charge so much for it.
Unfortunately, pharmaceutical companies do this all the time; they change the formulation of an old drug slightly in order to get a "new" patent on it, and then charge astronomical amounts of money for the supposedly "new" miracle drug with supposedly different effects. This is a shady business practice, to say the least, and especially abhorrent because its taking place within the medical industry, in particular with psychiatric meds. Profits over people. And doctors seem to fall for it. They prescribe the expensive "new" drug instead of the old, cheaper alternative, knowing most folks won't have to pay the higher prices because of their insurance. Everybody makes money, and the patient thinks they're getting something "new and improved".
It was now a few days into my second month of Adderall, and I was all out, and had to call up the clinic to renew my monthly prescription. I explained to the nurse that the meds were fine, but the cost was far beyond my ability to pay, and would the doctor please change it to generic dextro-amphetanine,  15 mg/day, either tabs or extended release spansules (yes, I looked all this up on the internet) as they would cost only about 25 dollars a month. She said she'd get back to me.
They didn't call back later that day (yesterday), and I'm about 3-4 days w/o my meds, with an important job interview coming up this Wednesday (tomorrow). 
So I called them up to see what was going on.
I did not talk to the doctor, only his nurse, and she said the doctor would not change the prescription to a generic dextroamphetamine because it would not be "a good idea", whatever that means. He presumably believes Adderall has less of an abuse potential. It certainly is abuse-proof if you can't afford to fill the script.
I am not too happy about this. Actually, I'm pretty mad. What do I do? Argue with the doctor?
He seems to think the very expensive Adderall is nice and safe, but the inexpensive dextroamphetamine is extremely dangerous and addicting, which is exactly how Shire is marketing Adderall XR to doctors (surprise). Does he even know they are almost the same thing?  Or is he "addressing my needs" professionally - by writing a prescription which covers his professional ass as a doctor, but deliberately making the prescription too expensive for me, thus preventing me from taking the "dangerous" meds? If he's manipulating me that way, he should lose his license!
Furthermore, my life is monitored by the people at the methadone clinic, including my counselor who I've known for 7 years.  She thinks I should get the meds, and has no problem trusting me. I meet with her at least once a month if not more often, and go there to pick up 2 weeks worth of methadone at a time, a privilege only granted if your life is stable, and behavior is exemplary. There are several folks at the clinic who take stimulants for ADHD, as well as their methadone, and there have been few problems. Actually, studies have shown recently that people with substance abuse histories actually improve their lives when they're treated with small doses of amphetamines.
By the way, they do make generic Adderall tablets, but not the XR capsules. Even the generic Adderall is about a hundred bucks a month! The cheapest and closest drug to Adderall is dex. The non-amphetamine drugs available like Strattera are also incredibly expensive and out of the question for me to purchase. I do not qualify for MA because I don't have kids. The doctor knows or should remember that I don't have insurance, am unemployed for now, and cannot afford anything but generics.
This seems like BS to me. I'm guilty before proven innocent. Am I correct? I should get the dextroamphetamine, right? He's already agreed to prescribe amphetamines, so why the refusal to give me generics? There can't possibly be that much of a difference between the two, is there?

My husband works for "a pharmacy retail chain" so your story sounds so miserably familiar....

And the Shire drug rep was in to see my psychiatrist right after my appointment today.  My husband and I had the "did-he-sell-his-soul-to-work-for-a-drug-company" debate.  Incedentally, he was providing Daytranna, which she started me out on, and today she prescribed me the dextroamphetamine you're after. 

Is there any way you can get a different doctor?  I have a great primary care doc who recommended me to a psychiatrist because she's uncomfortable with properly diagnosing and making medication choices for ADD.  It seems that you've done your research and are honest...perhaps you could make your case better with someone fresh, even though this guy seems to barely know you.

I also hate to play this card, but I worked for a doctor once who was very bigoted against many people, including those without insurance AND anyone with a psych history. 
Well, I got an appointment with my Doc for tommorow AM. At least we can talk this over sooner rather than later, in a week or two.
I think I also just figured out why he's afraid to give me generic dexadrine: he probably thinks I might snort it!
Adderall XR is apparently snort-proof. Some articles I've read about it say Adderall can't be "abused" because it's made out of little plastic beads or something.

That's so funny. I would never have thought of snorting generic dexadrine. Pills that large contain way too much cornstarch or cellulose or whatever they make them with. The actual drug itself comprises only about 20-30% of the pill. The result is; you might get a fast buzz if you snort it, but half the drug just drips down into your stomach anyway, and you'll have one hell of a ****ed up sinus condition with all that crap stuck up in there!
Their reasoning behind the claim that it's harder to abuse is just that... the drug being enclosed in the two seperate beads for their time release effect is supposed to discourage abuse.  Yeah right, like a person might look and say "oh darn" (or something to that effect), "I won't get the drug full strength effect since those little beads won't let me have the other half till later, duh..."  I guess they figgure a drug abuser isn't bright enough to BREAK IT UP BEFORE THEY SNORT IT.  Granted a dumbass might swallow that, but to use that as a selling point and get away with it?  Now thats drug abuse big time.Well, I just got back from seeing him, and his primary concern was not abuse - it was because I smoke and I'm old enough to start being concerned with heart trouble!! He seems to think Adderall is "safer" on the cardio-vascular system than plain slow-release dex.
Of all the craziest things!
He did agree to write a one-time, single month's supply of generic dex, though. He also prefers that I see a psychiatrist about this ADD stuff. He's right, I should.
If you are unemployed and uninsured you can call shire and get an application for the Patient assistance program.  With approval, you may be able to get the med (adderall XR) free or at a nominal cost, i.e. .00 a month.  It is all income based, so you will need to supply income verification of income.  Most drug companies have patient assistance programs to help patients that do not have insurance obtain their needed meds.  If the dex does not work out, call shire and ask....all they can do is say no!Hey everyone,

I came across this thread and thought I might have some helpful input.
One being some of the things said about Dexedrine (dextroamphetamine)
and Adderall. Adderall is made up of four amphetamine salts. Half of
Adderall is dextroamphetamine and the other half is levoamphetamine.
So, Dexedrine is simply half of the ingredients of Adderall. Everyone
reacts differently to them, so it gives people more options and variety I
guess. Also, dextroamphetamine is a Central Nervous System stimulant,
whereas levoamphetamine is a Peripheral Nervous System stimulant.
Adderall, because it is made up of both, can give someone a different/
more coverage than only dextroamphetamine. To convert them then, I
guess you'd say a 30mg capsule of Adderall XR would have about 15mg
of dex.

As far as the prescription cost being high for the stimulants you're using,
I've found that Costco is the cheapest pharmacy. I got 90 Adderall IR
10mg (generic) for about . A different time, I got 60 of them for like
. There is not a generic form of the XR version, unfortunately.

Seabat, I'm not totally sure as to the doctor's reasoning in prescribing
Adderall and not Dexedrine (brand name or generic). But they have, as
far as I know, not been the greatest thing for people with heart
conditions...but you never said that you actually had one...

Also, as far as the Patient Assistance Programs, I can personally attest to
how helpful and great they are. I don't have insurance and so it would be
impossible for me to pay for the medications I've taken. I have been in
the patient assistance program for Strattera and am currently doing the
patient assistance program for Wellbutrin XL and Lexapro. I have run into
one company that does not do these programs and it's the maker of
Buspar (anxiety med)...but the generic was only about 7 dollars for 60
pills at Costco . I am also currently going through the application
process
to recieve Adderall IR and/or XR from Shire, for which I can't wait because
I haven't even tried the Name Brand Adderall IR/XR before.   

If you would like to look further into this I would either contact the
pharmaceutical company or talk to the other people that you see
(counselor/nurses/the clinic). There are certain qualifications for the
programs and each company seems to have a different application
process, but it's definitely worth the wait.

I hope some of this helps and if you have any questions or whatever,
don't hesitate to ask!

ericyou know wal mart has a medician thing that if you can not afford your meds and you qualify to get them for like four dollars a script...