How Not To Get A Covid Vaccine

I read a few weeks ago that the CDC recommends two doses of a covid vaccines this winter for people at high risk of serious disease. So having been vaccinated in September, I asked my primary care provider if I should get a second dose.

Yes, good idea.

Can you write me a prescription?

You won’t need one, just go to the pharmacy.

Okey dokey. I went off to the pharmacy. 

There’s no one on staff who can give it to you right now, but you can make an appointment.

I was already so aggravated about the rumpus over the underfilled prescription that I walked away to calm down, and left my always supportive spouse to continue the conversation; she made dates for the next morning.

Next morning: a phone call.

We can’t give you the vaccine, it has to be at least six months after the previous dose.

The CDC: the minimum interval is two or three months, depending on the manufacturer. I have no idea which kind I had last time, but it’s been almost five months; I contact my doctor. She writes a script. I go back to the pharmacy.

How old are you?

62.

We can’t give you the vaccine, you have to be over 65.

I have a prescription from my doctor because I’m at higher risk.
You need to have a condition.
My doctor said she sent a prescription, did you get it? 

We have it. mYou need to have a reason. What condition do you have?
You need to know that?
Yes.*

There’s a line behind me now. She takes my deets, gives me a form to fill out, and goes off to run my insurance information.

It’s expired.
The policy I had expired, but I’ve had a new one since December. It’s on record. I’ve filled several prescriptions.
They’re saying it’s expired now.
…..
…..
Do you have a card?

I hand it over. She huddles with three or four other pharmacy employees. The line behind me is getting long. She comes back, hands me a printout.

Your insurance won’t cover it.

How much is it?

Over a hundred dollars, I think. I’ll go check.

…. 

$245.

I look at my very patient spouse, who has been waiting, patiently, behind me. The line is about ten deep by now. She nods. I get out my credit card. 

Administrative Burdens of Being Sick: Drugs

I sat down the other morning to fill my pill sorters for another month and discovered that the pharmacy only dispensed ten pills, instead of 30, for the prescription I’d filled the previous day.

I called them up and left a message. No reply.

I drove back to the pharmacy with the bottle. Did my doctor’s office make a mistake in the prescription, or was there a mistake in filling? Good question, said the pharmacist.

Tap tap tap.

We ran out, he said. We don’t know when we will have more. No, we can’t call you when we get more in. No, we can’t give you the rest of the prescription. You’re going to need a new prescription from your doctor. And you can’t fill it for ten days.

I got so frustrated I walked off to calm down, and then went back and apologized to the pharmacist for dumping drama on their day. They were very, very nice about it.

It’s of those ADHD meds. A controlled substance. So the hurdles for filling the prescription are high, very high. 

Once, I waited for half an hour in a busy CVS because the pharmacists had to keep the stuff in a vault, enter a passcode, and wait three minutes. They kept missing the window to open the safe because they were busy helping other patients.

Everyone needs their meds.

But why shortages?

It’s not just ADHD meds — weight-loss drugs and antibiotics also regularly run short, making patients sicker (and sometimes dead) while doctors sink even deeper into bureaucratic quicksand. Almost nine out of ten primary care practices, and one in five patients, struggle to get the medications they need.

For one thing, there’s a profit motive. Is there ever not a profit motive?

Pharmaceutical companies aren’t doing research on antibiotics because they don’t think they’ll make money on them. Insurance companies pay as little as they can manage — which seems reasonable given the cost of drugs with no generic equivalent, but then pharmacies lose money and stop stocking the meds. Which brings us back to the manufacturers, and how they use legal games to keep patents in force.

Albuterol, a widely used asthma medication, was developed in 1966, first sold in 1969, and patented in 1972. The most recent patent expired, finally, in 2020. 

But the supply of ADHD medications has unique limitations.

The DEA says ADHD meds are addictive and controls how many pills can be made every year. In 2022, they cut production of one group of ADHD drugs by almost 30%, resulting in immediate shortages. Drug manufacturers exacerbated the issue by failing to produce their full quotas.

Meanwhile, Covid lockdowns saw ADHD symptoms get worse among young people worldwide, while ADHD diagnoses zoomed* among adults, as demands on executive function increased dramatically with remote work and school. This predominantly affected women, because they (we!) do most of the child and elder care, and because girls with ADHD are so often called ditzy and spaced-out — or misdiagnosed with anxiety or depression.

When I was diagnosed with ADHD and finally started meds, I could suddenly get things done, which made me realize I wasn’t actually lazy, disorganized, and dumb, which in turn vastly improved my mental health. Go figure.

But why are ADHD meds even regulated? 

The idea that disease is caused by weak discipline or poor life choices is widespread and long in the tooth. 

Mental health stigma is particularly deeply ingrained. Denial that ADHD even exists persists, long after it was added to the DSM in 1980 (as ADD). No one (I hope!) would object to stabilizing a broken bone with a cast, but the current US Secretary of Health thinks medications for depression, ADHD, and weight loss are a threat to Americans’ health.

Despite claims of soaring stimulant abuse, 1.4 percent of people older than 12 misuse ADHD medications, and the numbers have gone down in the past decade. 

It is hard to find data on adverse effects experienced by people who misuse ADHD drugs, partly because studies of overdoses often lump them together with other  prescription and black-market stimulants. Large studies of adverse effects associated with ADHD medication abuse report rates of serious side effects between 0.2 and 0.4 percent, though smaller studies have found higher rates; a handful of deaths are reported (pdf, page 106).

For context (pdf, pages 2, 10): In the US in 2024, almost three out of five people older than 12 had used any illicit drug, consumed alcohol, and/or used tobacco in the month before they were surveyed; one in five binge drank. More people used cocaine (1.5%) or hallucinogens (3.6%) than took ADHD medications they hadn’t been prescribed (1.4%, pdf, pages 10, 12, 17).

More context: Drug overdose killed 80,000 people in 2024. Drinking caused about 178,000 deaths annually, in 2020 and 2021. Tobacco use is linked with half a million deaths every year. 40,000 people died in car accidents in 2023.

Medication is really helpful for people with ADHD. 

People with ADHD who take medication have 40% fewer injuries in car crashes. Women on ADHD meds are 41% less likely to commit crimes. (Among men, it’s 32%). Both men and women are 31% less likely are to abuse non-prescription drugs, an effect that holds even after they stop taking ADHD meds.

On top of that, people with ADHD are at higher risk for dementia — but not if they are medicated for it. Fifty percent of people older than 75 are expected to get dementia, mostly women, and it’s not just that we live longer: at any age, almost two times more women than men get diagnosed. 

I’m not likely to start committing crimes or taking cocaine, but I’d love to live out my life without losing my mind, or at least, not losing more of it than Long Covid already took.

And I would love to know why it’s harder to get medication for ADHD than it is to buy a cigarette, a bottle of tequila, or a car.

“You Can’t Know Until You Try”

Visiting Florida, my then-partner and I talked about our plan to go to Universal Studios next. My grandmother got out a faded technicolor photo album from her trip to Disney World in 1970.

I got the hint.

“Do you want to come with us?” 

“Let me think about it.”

                …

“If I go with you, I’ll need a wheelchair, and then we’ll get to go to the front of all the lines.”*

At Space Mountain, if I recall correctly, signs warned that the ride — Raiders of the Lost Ark? — was intense.

“Are you sure you want to go on this one? It won’t be too much for you?”

“You can’t know until you try.”

It was a little too much for me, but not for her. I have such happy memories of that day, because my grandmother had such fun.

========

The Long Covid learning curve is a never-ending thing. Would it be too much for me to go to my cousin’s diving meet? 

Diving rounds, it turned out, ran simultaneously with swim heats. There was a lot of cheering, whistling, clapping, and general exuberant happy college student energy bouncing off the walls. I found a seat at the back, put in the earplugs, started taking photos.

I watched the various dives, recalled my own brief period of diving lessons, wondered what might happen if I tried a back flip now. When the dull roar crescendoed into deafening rumpus I put my hands over my ears. I was having a good time. 

After 30 minutes I stood up to leave. My stomach threatened revolt, my legs were weak, my balance was shot; I took the stairs carefully, gripping the rail. Back home, I staggered in the house and dropped into bed.

Catherine, bringing me tea: “was it worth it?” 

I don’t know. 

I’ve been working an hour a day, maybe two, trying to finish editing a book. I try to pace myself carefully: if I push myself too hard, I can’t work the next day. Or days. Or weeks. My eyes don’t focus. My short-term memory, gone. I can embiggen the type, and read the letters and the words. I can follow a short sentence. Anything longer, my brain runs out of memory buffer. I can’t hold on to it, so I can’t process it. 

The rest of today is shot. Tomorrow? I won’t know until I get there. 

========

* Not a scam. My grandmother could stand, and she could walk. But she couldn’t stand in line for an hour or two, and she couldn’t walk miles around the park all day. Even the distance from the parking lot to the main gate would have wiped her out.

See someone who looks like they can do stuff, sporting a handicap tag? You have no idea what they’re carrying. Don’t judge.