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Infuriating appointment today (self.adhd)
submitted 2 months ago by TheBluePillock to c/adhd
17 comments fedilink hide all child comments
 

Sorry if this is the wrong place, I just really need to vent somewhere.

I had a followup today to discuss the next steps since neither guanfacine nor atomoxetine worked out. I've been waiting for this because I know stimulants are the first line treatment and I've had nothing but awful experiences with the other meds. He had me take a drug test ahead of time - to make sure I wasn't already taking stimulants, he said. I've been open about everything I'm on and he said it would be fine. That was a lie.

I tested positive for a bit of weed, which I told him about. It's legal in my state. Despite saying it was fine before (I asked, specifically), now he changed his tune and said he's going to keep testing me and if I test positive three times he won't prescribe me any stimulants.

The kicker? I even have a prescription for it, because I worry about exactly things like this. It's for chronic pain, but tbh helps my depression and anxiety too. I don't even use much - about $150 in edibles over the last year. But if I spent that much on alcohol every weekend, that would be no barrier to getting a prescription.

I went in for help and was nothing but honest, and I left feeling attacked over prescription medicine that's been helping me. What the fuck. I'm so frustrated and angry I just want to cry. Why is it so hard to get help?

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[–] [email protected] 29 points 2 months ago (2 children)

If it's legal in your state, I would expect there would be some sort of medical board you could report him to. Either way, this might be a sign that you need to find a new GP, if they are explicitly stating that they are going to refuse treatment over a drug test showing something you have a script for.

Small question: Did you remind him he had told you it was fine previously and that you had a script for it? It might help to state the question very directly: "I just need to make sure we're on the same page here. You are refusing moving forward with the next steps of care due to a drug test showing positive for a substance I have a perscription for?"

You can't assume they'll remember this shit or be aware of your other scripts. A new person took over for my retiring GP and somehow got the bright idea to refill me at double my fucking dosage. Supposedly it was recorded that way in my file (despite never being a problem for literal years).

[–] TheBluePillock 6 points 2 months ago

Yes, I brought up that we already discussed the edibles. Given how long after use you can still test positive I told him the results probably wouldn't change, and he straight up said that if I don't stop using it entirely then he doesn't want me as a patient. It felt so judgmental, and that part of it really upsets me too. I promise I'm not that exciting lol

Sorry about your medication mix up. Every time they have me update my info it has a list of all the meds I'm taking and I'm supposed to correct any dosages that have changed or cross them out if I no longer take them. Every time I cross out the same ones and re-correct the dosages again. My file has a totally different picture from reality - it's kinda scary.

[–] [email protected] 2 points 2 months ago

Decriminalization or "state-legal" != legal, it's still federally illegal so I doubt a medical board will give a damn unfortunately.

[–] [email protected] 17 points 2 months ago* (last edited 2 months ago) (1 children)

That's outrageous, you shouldn't have to deal with this bullshit.

I agree with the other reply - report them and find a new GP, I know that's a massive pain and hassle, but it's so important to have a medical team that is there to help you make your life better, not judge and police you according to their own questionable morals.

[–] TheBluePillock 4 points 2 months ago (2 children)

Thankfully it's not my GP, but yeah it's time to find another provider and start all over again. I went looking for a psychiatrist to manage my meds for a different reason a month or two ago and struck out half a dozen times before running out of steam, so it's a little easier said than done. I'll get there eventually, just ... it's weirdly difficult to get help and executive dysfunction can be a real bitch. I won't miss this provider though, so that's some motivation!

[–] [email protected] 4 points 2 months ago (1 children)

it’s a little easier said than done.… it’s weirdly difficult to get help and executive dysfunction can be a real bitch.

Oh 100%, executive dysfunction really is an absolute bitch, and getting through that wall can be the hardest fucking part!

Not to mention just how hard it can be to find medical staff that isn't burnt out to the point of not giving a crap.. :/

I know it seems like just adding an extra step, but have you considered checking if there are any (volunteer) patient advocacy services available near you? I have some other difficulties too, so more help might be available to me, and also I don't know where you are, in US it might be too big an ask, but having an advocate has been a game changer for me - they help make calls for you to arrange appointments and follow ups and stuff, help liaise with staff if you need them to, basically they jump a lot of the hurdles for you to help you get to where you need to be.

If something like that isn't available, is there anyone in your life that you'd trust to advocate for you? In any case, you'd need to give permission to your provider to speak to them on your behalf, which again seems like just an extra step, but I really think that sharing some of the burden of acting with someone else can be a great help (though it might not work for you, and that's ok too).

[–] TheBluePillock 2 points 2 months ago (1 children)

I have a friend that helps me with some basic stuff, but in recent years they've gotten busier and more stressed, and I'm always going to have them put themselves first. They still help a lot, but it has gotten harder when they can't help and I don't get my own shit together. I'm embarrassed to admit how long it takes me to find a new doctor or therapist. I've never looked into an advocate, though. I don't think I'd qualify, but I'll definitely take a look, thanks!

[–] [email protected] 2 points 2 months ago

Yeah, it can be hard because everyone has shit going on, it's why having someone in your life whose specific job is to help you with stuff like this is so helpful, because it feels less like pilling on to someone else. You can of course hire a PA, but that becomes expensive, but it's definitely worth looking around, try ADHD/neurodiversity specific charities or organisations, but depending on your circumstances you might qualify for other types of places too.

Also, don't be embarrassed, I've taken years to sort shit out, life is already so overwhelming, having additional barriers to deal with these aspects of life can make it almost impossible at times. You're doing your best.

[–] cornshark 1 points 2 months ago (1 children)

How did you end up striking out? Not taking new patients? Also wouldn't accommodate marijuana use?

[–] TheBluePillock 2 points 2 months ago

Lots of not accepting new patients and places that never end up calling me back even after multiple tries. Websites which specifically said they had availability were not accepting new patients when called. It's exhausting.

[–] QualifiedKitten 9 points 2 months ago (1 children)

Ugh! I'm so sorry, that's so frustrating! I'm dealing with something kinda similar, and I can't help but feel like they're just trying to set me up to "fail". I've been on dextroamphetamine XR for over 10 years, and with my current doctor for 4 years. I recently got a phone call saying that I'll have to provide a urine sample before they authorize any more refills. When I asked why, all they would say is "it's policy."

I'm also in a state with legal recreational marijuana and partake intermittently (probably similar amount as you), and have been very honest with my doctor about that. Additionally, I end up skipping doses sometimes when the side effects (jaw clenching/pain) outweigh the benefits, which is another thing that I've discussed with my doctor.

I was planning to switch insurance plans (and therefore doctors) in the new year, so this just gave me one more reason to follow through with that plan.

[–] TheBluePillock 3 points 2 months ago

If you are also in the US, I suspect the reason why is the looming threat from the DEA. Even if you are not a telemedicine patient, if your doctor's office offers it as an option then they're probably applying a blanket policy to everybody regardless. I hope they don't treat you as badly as they did me. Depending on the doctor, they could still elect to allow your marijuana use. It just means if they get audited, they have to justify why they're prescribing stimulants to a marijuana user. There is no reason not to and you have a long history of benefitting from the medication, so it should be clear cut. But the doctor may still decide it's not worth the hassle or risk, like mine did.

Had I known ahead of time it might be a problem, I would have abstained as long as possible before the test (preferably over two weeks) and looked into detox drinks and other fast detox tricks. Worst that happens is I fail anyway and wind up right where I am now: needing to find a new doctor. But it could have saved me the trouble of needing to switch so soon. Maybe it can buy you some time.

[–] [email protected] 9 points 2 months ago (1 children)

He seems completely incompetent altogether. I expressed concern that a stimulant would not be right for me, as even coffee has an extreme effect when taken after a long pause. But everybody, GP, therapist and psychiatrist, insisted that we should try MPH or AMP, as it is so much better, even though the whole prescription process is complicated for a schedule 2. And it worked out great from the very start.

He seems to worry about the wrong things. To rather let a patient in his care suffer with 3rd choice meds for months (?), followed up unmedicated than take the chance that you might be a 1%er who abuses it. For which there isn't even much indication, as you have a prescription.

However, if I really try to give him the benefit of a doubt: A quick search shows that there are some risks in combining weed and medical stimulants. The positive effect can be reduced, and cardiovascular risks of stimulants increase. So, without medical training, I don't know if that means that you have to search for alternative for either of those first (switch either the pain meds or the ADHD meds), and then continue treatment for both, or if it really is so risky that you absolutely must keep one of the conditions untreated. As far as I understand, weed is rarely the only option and, at best, only slightly better than the next best alternative. For ADHD, on the other hand, MPH or AMP or so much better than the next best alternative. I tried Modafinil myself, and the side effects were severe.

So maybe his tone was just off, and he should have explained those careful considerations for the best therapy options, rather than be like "eek junkie, get out until you are clean".

I might be completely wrong here, it's literally what spins off in my head after 2 minutes of search.

[–] TheBluePillock 6 points 2 months ago

I don't think it's a medical reason. If my cardiovascular health were at risk, stimulants alone would be a bad idea. I'm healthy enough and my usage is minimal. He tossed out some BS about working memory, but if I go down that rabbit hole this comment will get 5x as long.

The benefit of the doubt here is he's covering his own ass. The DEA has been threatening to crack down on stimulant prescribers for a while, especially over telemedicine (which this was). If he gets audited and has to justify why he's prescribing stimulants to a drug user, he could lose his medical license - or he may just not want to deal with the research and extra work needed to write up that justification.

To that end, it fucking sucks, but I can't really blame him. I just wish he had been more honest and up front with me like I was with him. We could have waited a month to take the drug test and I'd have passed it, then this whole thing could have been avoided. Instead he looks down on me and repeatedly hasn't truly listened to what I've told him. I won't pass judgment on him the same way he did to me, but I will say his style is incompatible with me as a patient. I'm an active participant in my own care and I need a doctor who will form a collaborative relationship with me, not dictate treatment decisions.

[–] Ceedoestrees 5 points 2 months ago (1 children)

The treatment gauntlet is brutal. I've done illegal drugs before, but now I just microdose mushrooms in addition to my prescribed stims, which were legal the last place I lived, where my psyche knew about and okay'd it, but not here. They wanted me to come to the hospital daily to get my meds and take weekly piss tests. I average about one alcoholic drink a week, so it's fucking ridiculous knowing people who get wasted three times a week who have no problems getting meds.

It's hard to get help because medical doctors are just people who won the birth lottery for financial stability and they're skilled at rote memorization. They don't have to be smart or better than average at their jobs.

[–] TheBluePillock 3 points 2 months ago

wtf, meds by the day and weekly piss tests? Damn that's brutal. Is it because of where you live or do they know about your drug history and just treat you like shit because of that?

That's what really gets me: they'll vilify someone using a harmless medicine in moderation for treatment purposes, but completely overlook people who get totally fucked up on alcohol on the regular. It's so backwards. I avoided weed for decades until it was prescribed to me because "drugs are bad" and it didn't take long after trying it to figure out what a ridiculous lie that is. Not all drugs are equal, and alcohol is worse than at least a few.

[–] MrPoopyButthole 3 points 2 months ago

Ugh, that's awful. I would try a new GP.