I am one of many living with Adult Attention Deficit and Hyperactivity Disorder (ADHD) in the United Kingdom (as of 2021, 3-4% of the adult population are diagnosed in the UK, and  2.6% in the the United States) although it is now thought that the neurodivergence could affect significantly more people than are currently diagnosed.

What is Adult ADHD?

The ADHD brain, through MRI studies, is known to struggle to produce dopamine effectively, which is the neurotransmitter vital to giving people the basic motivations to conduct normal beneficial and required functions in society.  One of the most effective treatments for Adult ADHD is to stimulate the brain with the dopamine it can not produce, via the closely-monitored prescription of low doses of amphetamines (known as the street-drug "Speed").  In the ADHD brain, this results in the reduction of the feeling of being unable to push oneselves to start, and finish tasks, which the neurotypical brain can accomplish with relative ease or willpower (which itself is a self-actuated dopamine increase effect).

My Experience with ADHD Medication

The vast majority of patients diagnosed with Adult ADHD respond well to one or more of the currently available medications, and we are very thankful that these medications are even available at all, given their reputation amongst the general public.  They allow us to live a more normal life, with a reduction in the noise, narration and role-playing in our minds, and an easing of the feeling of inability to start, and finish basic tasks that neurotypical people can accomplish either without thinking about it, or with a little bit of self-motivation, which is an ability Adult ADHD inhibits through the ineffective dopamine production in our brains.  My personal experience with Elvanse and Amfexa, two commonly prescribed medications for ADHD, have proved less effective than hoped, despite initial promising results from Elvanse, however tolerance was quickly attained and the medication began to reduce in its efficacy for myself. Unfortunately, there is currently no alternative in the UK to increase potency of the medication. My Initial treatment with Methyl Phenidate proved to be even less tolerated. 

Abuse Potential Examined

An adult that takes amphetamines for their ADHD does not feel like they are taking what is essentially, an illegal Class-B drug with a poor reputation for abuse.  The medication simply lifts the patient's willpower to a normal level.  Most patients report simply, that the medication makes them feel "normal".

Abuse potential is high with the street form of the drug, "Speed", because dosages are not monitored, and quality is far from pure, leading to an unsafe medication before it is considered that a neurotypical brain already has the normal level of dopamine, and additional stimulation will result in extremely hyper focused, often non-important activity, such as the typical adage of a person using "Speed" obsessively cleaning a single tile on the floor for hours.  This behaviour DOES NOT occur when an ADHD brain is given an appropriate dose of amphetamine.

A patient with ADHD, prescribed an appropriate dose of amphetamine-based medication, will feel relief from their symptoms, and will rarely seek to "chase the high", as the "high" is merely an improvement in their ADHD symptoms.

What Happens When Treatment with UK-Licensed Medications Fail?

Efficacy of Elvanse is reported  by patient studies as "Efficacious" and Amphexa is also reported as "Efficacious".  This means that most people will feel a positive result from these medications, but a significant amount of patients will continue to feel no improvement, or a tolerance will build, and the improvement in symptoms initially will subside.  In this case, currently in the UK, treatment will then be said to have failed, and the patient will only be offered therapy support.  People who have found themselves to be treatment-resistant to stimulant and non-stimulant medications in the UK demonstrate increased psychological problems such as depression & anxiety, and a feeling of helplessness, from the knowledge that their treatment has failed, in addition to uncontrolled ADHD symptoms, which can be severe and life-limiting.

Further ADHD Medication Options ARE Possible

In order to increase the options available to ensure more adults with ADHD are able to be treated effectively, It's time we consider more alternatives like Adderall, that is available in the United States under license from Takeda Pharmaceuticals U.S.A., In as well as (the last-ditch option) Desoxyn, from Ovation Pharma.

It does not make much sense that medications proven to be effective in the treatment of ADHD are available in one country and not another.  A private psychiatrist in the UK can at their discretion prescribed the modified-release form of Adderall, off-label, for treatment-resistant ADHD, however not many professionals like to take this risk, and the cost is prohibitive at around £400 per month.

Adderall is currently not licensed by the Medicines and Healthcare Products Regulatory Agency UK and as such is not licensed for use on the NHS.  In addition to this, most private psychiatrists will not be willing to take on the risk of prescribing an off-license medication for insurance purposes.

Adderall has shown to be have a wider efficacy than Elvanse (branded as Vyvanse in the United States) and Amfexa as it contains the pure Amphetamine salt in combination with dexamphetamine as opposed to the potency-reduced (proto-drug) lisdexamphetamine in Elvanse and dexamphetamine alone in Amfexa. This is not just my personal observation but is backed by research studies that have found Adderall to be a more potent treatment option (source: Journal of Clinical Psychiatry). The potential for addiction, often a concern when discussing medications like these, is low according to numerous studies (source: American Journal of Psychiatry) due to closely monitored prescriptions and dosages by an approved psychiatrist.  Adderall was prescribed to 41.4million patients in 2021, who report it to be "highly efficacious" with a moderate side-effect profile.

However, despite this evidence and the positive experiences reported by patients abroad where Adderall is licensed, it remains unlicensed on our National Health Service (NHS). This leaves many individuals without an effective solution for managing their ADHD symptoms when existing medications have either failed, shown limited efficacy or ill-tolerated.

A Last-Ditch Option in the United States - Desoxyn

Desoxyn, is the prescription form of methamphetamine, and is used as a final option to treat severe ADHD where all other treatments have failed.  Most people will find improvement from existing treatment options, with a significant percentage finding that the option of Adderall is sufficient for improvement to be demonstrated.  However, in the most severe cases of treatment-resistant ADHD, Desoxyn has shown to be universally effective, however, the side-effect profile is also severe, so treatment with this option is extremely limited, being prescribed to around 16,000 patients in 2021.  In a very limited number of cases, the guaranteed efficacy may be preferable to the severe side-effect profile, especially if the patient demonstrates adequate tolerability to the medication and their personal side-effect profile is acceptable. 

Summary

Adderall has been shown to balance the increased side-effect profile compared to lisdexamphetamine and dexamphetamine with a significantly higher efficacy and should be an option for the many people in the UK who find Elvanse and Amfexa to be ineffective or ill-tolerated.  

We should also start a discussion about whether Desoxyn should be available in the most severe treatment-resistant cases of Adult ADHD.

By signing this petition, you are supporting thousands of individuals like myself who are seeking better treatment options for their ADHD. Let us advocate together for the licensing of Adderall on the NHS, (and potentially at least discuss the existence of Desoxyn, with its advantages and disadvantages) in order to provide an alternative and potentially more effective treatment option. Please sign this petition today!