A faculty speaker for the Neuroscience Education Institute (NEI) for many years, I have been invited to present several talks on adult ADHD and the complexity of medications. There are currently 28 different ADHD stimulant preparations (my last count). While there are only 4 different chemical compounds (methylphenidate, d-methylphenidate, amphetamine, d-amphetamine), the technologies delivering medication have exploded. With so many options, individual selection for each patient is possible. Good news for patients. Confusion for prescribers.

One of my presentations will focus on how to think through the medication options. How do you decide on the chemical compound? How do you select the delivery system? What medications interactions are concerning and what are not? Will side effects change if the deliver system is changed, even though the medication compound is the same?

Patients can help prescribers understand their experience with the medication by describing:

1. What positive cognitive effect do you notice with the medicine? What time do you take it and when do you notice it’s cognitive effect wearing off.
2. What side effects do you notice and when do they occur relative to taking the medication? Do the side effects occur 1-2 hours after taking medicine or do the side effects occur when it is wearing off? What side effects are subsiding and which ones are persisting?
3. Can you afford the medicine? There are large price difference between medications. Without understanding the range of options (remember: 28 different stimulant preparations), you may not know there is a more affordable option.
4. Can you swallow the medicine? There are several different forms: tablet, liquid, chewable, patch. All these forms have long-acting delivery systems so once daily dose is still possible.

The biggest challenge for prescribers now is the obstacle of insurance prior authorization and approval. This is an increasing frustration for patients and prescribers who work hard to find the right medication only to have insurance companies “decide” what medication is “appropriate” for you, the patient. Work with you prescriber to negotiate this obstacle course. Every time a patient changes insurance policy, these issues raise their head. Even if you have been stable on medication, the new insurance policy may deny future coverage. Oh, boy. Now that’s scary.

Believe it or not, I intended to describe my upcoming talks in April but got distracted by what I believe are important issues for patients to understand. It is the doctor in me to come back to the patient treatment and benefit.

Thank you for your valuable time. David W. Goodman, M.D.

Addendum: Because of COVID-19, this Neuroscience Education Institute conference was postponed and has been scheduled for Colorado Springs, Colorado November 5-8, 2020.