The Story of Vyvanse
By Bethany Sneathen and Dr. James Stahl
You’ve probably heard of Adderall. You may or may not realize it’s nothing but amphetamine. Stimulants like Adderall have been used for the treatment of ADHD since the mid-20th century. They’ve been abused for just as long (if not longer) for recreational or performance-enhancing purposes – one recent study showed that over 5 million adults in the US (around 2% of the population) misused prescription stimulants in the past year.(1) Because of this, it’s perfectly reasonable that drug manufacturers would seek to develop a version of the drug that has the same clinical benefit for ADHD patients without some of the features that lend themselves to the abuse of the drug.
Extended-release formulations offer some benefit in this regard. Usually developed to improve convenience and, theoretically, medication adherence, an extended-release medication is typically taken less frequently than its immediate-release counterpart, often thanks to a physical mechanism to slow its dissolving. In an abusable drug, a slow-dissolving mechanism means the user has a slow, consistent effect instead of a quick “high.” However, most extended-release formulations can be crushed, dissolved, or otherwise manipulated by someone wishing to experience the full impact of the drug immediately.
Enter Vyvanse. Vyvanse is a prodrug; that is, it’s a version of amphetamine that has been chemically altered to be inactive. It only becomes active once it enters the body and gets slowly converted back into amphetamine by the person’s own enzymes. According to FDA approval documents, “the sole rationale for this product, relative to other products in the stimulant class, is to decrease the risk of abuse.”(2)
But is Vyvanse truly a less abusable drug? Its drug label has the same Black Box Warning (the strictest warning assigned by the FDA when a drug carries a risk of a serious side effect) for abuse and dependence as other stimulants.(3) However, an abuse liability study is cited to show that Vyvanse is less abusable than immediate-release stimulants.4 Here’s how that study went:
38 subjects with a recent history of stimulant abuse were recruited
Over two weeks, each subject was given 3 different doses of Vyvanse, an immediate-release amphetamine, another immediate-release stimulant called diethylpropion, or placebo
After trying each drug, subjects were asked questions like “‘How much do you like the effects you are feeling now?” or how much money they would pay for the drug on the street
A somewhat shocking study design, but it does get right to the point. The results of this study showed that the middle dose of Vyvanse “produced significantly less ‘Drug Liking Effects’” compared to an equivalent dose of an amphetamine… but the highest dose of Vyvanse “demonstrated similar ‘Drug-Liking Effects’” as the immediate-release amphetamine!
Okay, so if you want to get high from Vyvanse, you just need to take an extra pill? That doesn’t seem too hard for a drug abuser to figure out! Indeed, all it takes is one quick Reddit search to find a plethora of opinions on the pros and cons of Vyvanse versus other stimulants describing subjective levels of focus, productivity, “smoothness” of the drug’s effects, delay and duration of the effects, and the “crash” experienced as the drug wears off for medicinal, recreational, or performance-enhancing purposes.(5)
So what is the value of this supposedly less abusable drug? Well, if you look at the cost of Vyvanse versus the cost of generic, extended-release versions of amphetamines, Vyvanse costs nearly 10 times more than the other products – a large cost difference that does not appear to be justified by the clinical evidence.(6,7)
Compton, WM et al. (2018). Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2018.17091048. Accessed April 24, 2018.
Food and Drug Administration (2007). Vyvanse Medical Review. Application No. 021977, p18.
Food and Drug Administration (2017). Vyvanse Label. ID: 4132023, p1.
Jasinski, DR and Krishnan, S. (2009). Abuse liability and safety of oral lisdexamfetamine dimesylate in individuals with a history of stimulant abuse. Journal of Psychopharmacology 23:4, p419–427.
Reddit.com. https://www.reddit.com/search?q=vyvanse. Accessed April 24, 2018.
Vyvanse Coupons on GoodRx. https://www.goodrx.com/vyvanse. Accessed April 24, 2018.
Dextroamphetamine Coupons on GoodRx. https://www.goodrx.com/dextroamphetamine. Accessed April 24, 2018.