prescription medication

It’s 7 a.m., and a police officer stops me at the gate of the only road that leads to Moon Island.

She asks me for my pass, which I scramble to retrieve from my messenger bag in the backseat of the car. Moon Island is a restricted property controlled by the city of Boston, even though it’s technically in the city of Quincy. But this is hardly the most bizarre or confusing part about my day. Because Moon Island is also the location of the Boston Police shooting range, and I’m here to take a target test so I can get my gun permit.

The officer furrows her brow as she checks my range pass, and I wonder if it’s that obvious that I’ve never actually shot a real gun before in my life.

She tells me to wait outside for 10 or 15 minutes because the range instructors don’t like it when people are early. This is the exact opposite of what the licensing officer told me when I scheduled my appointment three days earlier: "Try to arrive about 15 minutes early," she said. "The range instructors are nice guys, but they don’t like to be kept waiting."

Obviously, I’m off to a good start.

I drive across a land bridge and stand outside for a while, making small talk with some police cadets who are also there as part of their training. "You here for your permit test?" one of them says to me. "You’re the smart one." I’m not sure if this is meant as positive support for obtaining a gun permit or a joke about slogging through police academy. But it’s 7 o'clock in the morning, and I’m really not at my best.

When I finally walk inside the small classroom cabin at exactly 7:15 a.m., I make a mental note of the other people there to take the test — a white guy who looks to be in his 50s or 60s, a Hispanic guy in his 20s, and a straight white couple in their 20s or early 30s.

The instructor looks up at me, shakes his head, and says, "You’re late."

Then he hands me a bucket with 30 rounds and a .38 revolver.

Wait. Let’s back up. There’s something you should know about me before I go on about the shooting range: I have ADHD. And it has a huge effect on my life.

My brain is a massive ocean of too much information. Without my medication for attention deficit hyperactivity disorder, it’s easy for me to get lost in the undertow. No matter how hard I try to fight the current, I still get overwhelmed and distracted by every strange texture I feel beneath my feet. This never goes away.

All illustrations by Kitty Curran.

And the medications that do manage to help me a little? They aren’t easy to get.

One of those is Adderall. I remember back in the spring of 2013 waiting around at CVS when a frowning pharmacist called me to the counter. Thanks to its status as a Schedule II controlled substance (such as barbiturates or opioids), there are no automatic renewals for Adderall prescriptions, and the doctor can’t call or fax one in either.

So every month, the routine goes like this: I call the doctor’s office three to five days before the end of the prescription cycle (but no sooner than 21 days since my last prescription was filled), then wait a few days for the request to get from the receptionist to the doctor. Then I travel in person to pick up the new prescription and hand-deliver it to the pharmacy.

But it doesn’t always go smoothly — like on that spring day in question. I was sitting in the CVS after I’d already gone a few days without my medicine, which made me all the more eager to get back to my "normal" functionality as soon as possible. Unfortunately, the pharmacist informed me they were out of stock and weren’t expecting another shipment for a week. D’oh.

With my prescription in hand, I biked over to another CVS, but they too were out of stock and would be for a while. This time, the pharmacist explained that the country was in the midst of a national shortage of Adderall, which had apparently been caused by some confusing collision of agendas between the Drug Enforcement Administration, the Food and Drug Administration, and big pharmaceutical companies.

So I showed up at a third CVS that day and was elated to learn they actually had the medicine!

But 10 minutes of waiting turned into 15, then 45, and I went to check if everything was OK. It wasn’t. Massachusetts law requires pharmacies to substitute generic-brand medications unless otherwise specified by the doctor. But it turned out that my insurance only covered the name-brand version of Adderall, which they couldn’t give me because my doctor had not written "no substitutions" by his signature.

"Can’t I just write 'no substitutions' by myself with a pen? How would you even know if it was the doctor or not?" I asked.

"Well, I would know now," the pharmacist said. "And that would be fraud."

She had me there.

So I got back on my bike, went back to the hospital where I’d already been once that day, and waited in line again. I explained the whole scenario as I asked the receptionist to please just write "no substitutions" on my existing prescription. Because remember: These prescriptions aren’t accepted by phone or email or fax, and they’re only allowed to write me one a month.

After some five hours and 15 miles of biking back and forth (and enough stress to kill an elephant), I got my prescription. But that was just for one month. And while this was certainly a worst-case scenario, it’s unfortunately not so far off from every other month.

If you’re wondering what my monthly quest for ADHD meds has to do with buying a gun, you’re not the only one.

On Oct. 4, 2015, I was sitting in my parents’ couch, sipping on a whiskey, while my father watched CNN's coverage of the Umpqua Community College shooting that had claimed 10 lives just a few days earlier. We had just returned from a suicide awareness walk, and I couldn’t help but cringe each time the shooter’s mental health was brought into question by the news anchors, police chief, and other pundits. At one point, a reporter even questioned the shooter’s father directly about his son’s "mental makeup" despite the fact that the man was clearly in shock and mourning.

It’s the argument made famous by Ann Coulter: "Guns don’t kill people, the mentally ill do."

But the truth is far from that. Here are the facts:

People with mental illnesses make up about 20% of the population, and they are significantly more likely to be victims than perpetrators of gun violence in the United States. And more than half of gun-related deaths in the United States are suicides.

Realistically, less than 5% of gun-related killings from 2001-2010 were perpetrated by someone with a diagnosed mental illness, according to a study published in the American Journal of Public Health in 2015. Mass shootings in particular account for less than 1% of firearm deaths, and some sources project mental illness figure into only about half of those.

I mean, it’s just kind of hard to draw any useful predictions or conclusions from those kinds of fractions.

So as I sat and listened to yet another dour cable news expert rattle on about how the 20% of Americans who are like me are basically tragic but indisputable monsters because we have psychiatric conditions, I decided I'd just about had enough of this unfounded link between mental health and gun rights. I grabbed my laptop and decided right then that I wanted to investigate this system.

Within five minutes, I’d found a listing for a Cobra 380 Derringer Big Bore pistol in Kentucky. It was hot pink and only cost $114.95. I made a burner Google phone number and email address and sent a message to the dealer that I was interested.

He called me 10 minutes later.

People with ADHD — we tend to be a little bit impulsive. So it’s a good thing I live in Massachusetts.

Gun laws vary from state to state, and — as I would eventually learn during the licensing process — this is a major factor in our nation’s gun problem. While Kentucky’s laws are very loose, for example, all online gun sales in the country must be shipped to a licensed dealer in the buyer’s home state. This meant that my little pink Saturday Night Special was going to be harder to get than I had hoped because I’d have to obtain a Massachusetts gun license first.

But it didn’t take long for me to learn that there are plenty of simple and semi-legal ways around this, too.

Most gun-control rankings consider Massachusetts to be the third-strictest state for guns in the union; by comparison, Kentucky ranks around 42nd. Massachusetts also has one of the lowest rates of gun-related deaths per capita, although it’s only fair to point out that correlation isn’t necessarily causation.

But if I was really determined to get a gun, I could have just applied for a Utah gun permit (which is available to any U.S. resident by mail for just $49 and is recognized in 36 other states) then driven an hour north to New Hampshire and purchased a rifle there. Or, I could have changed my legal residence to my in-laws' house in Vermont — I do spend enough time there, even if it is legally questionable. In both cases, I could still purchase and own a gun, even though I legally could not use it in my actual home state of Massachusetts.

This a pretty good summation of how confusing, obnoxious, and generally manipulable our country’s state-by-state gun laws are.

It's important to note that I didn’t actually want this pistol. I didn't plan to use it all. But I wanted to know if getting a gun really was as simple as they said it was, especially given the bureaucratic frustrations that I’d already lived through in my attempts to get proper mental health care. Gun control advocates and gun enthusiasts always seem to be talking past each other, and I thought that if I actually learned firsthand about how to buy a gun, I would be better able to understand the arguments on both sides of that debate and communicate with people instead of at them.

(Also, the city of Boston offers a gun buyback program that pays $200 no questions asked, and I thought it would be kind of hilarious if I could make a profit off of a cheap, crappy gun.)

As tempting as it was to try and skirt the system just to say I did it, though, I decided to go through the proper Massachusetts licensing process to see what it was like. So I signed up for the next available gun safety course in my area — which was eight miles away — and started the course 16 hours later.

That's how I ended up at a plastic folding table in a desolate warehouse just outside Boston at 9 a.m. on a dreary Saturday morning.

The bulk of this wide-open industrial space was a lobby of sorts, littered with gym mats and home exercise equipment. There was an empty glass display case to the left where inventory should have been and a few decorative firearms hanging on a section of the wall. The classroom part was sectioned off, with a few NRA posters to add pops of color to the otherwise bland drywall.

I took a seat toward the center-back, behind a friendly middle-aged couple from the nearby suburb of Tewksbury. I was genuinely impressed by the diversity of the room — seven women, including a black woman and a Hispanic woman, and 11 men, including one Asian man.

The three-hour NRA-certified class cost $100 cash, and the first half-hour consisted entirely of an instructional safety video created by someone with the National Rifle Association. Maybe it was my ADHD, which in my case, is accompanied by auditory processing problems, but it was really hard to sit still through 30 minutes of things like this:

"When a gun’s trigger is pulled, a specific sequence of events occurs. First, the firing pin strikes the primer or case rim and ignites the priming compound. The flame generated by the priming compound ignites the powder charge. The powder burns rapidly and generates a large volume of hot, high-pressure gas. At this time, the case walls expand against the walls of the chamber to form a gas seal. Finally, the high pressure gas propels the bullet out of the barrel at a high velocity."

Did your eyes gloss over? Mine did. It felt like a driver’s ed teacher explaining the combustion sequence of the engine, which might save you some money at the auto shop but isn’t necessarily going to make you a more responsible driver. It's certainly helpful to know how a gun works, but these dry and overly technical hardware explainers didn't actually teach me much.

The "safety" aspects of the video were mostly focused on gun ranges, proper home care, and storage for the firearm. And there were occasional mentions that yes, you should also be carrying it on your person at all times. According to this video, all gun-related incidents were "accidents," which were only caused by ignorance or carelessness.

So what exactly constitutes "safe pistol operation"? This was made explicitly clear:

"Knowing all the gun's safety rules is not enough to ensure safe shooting. Having a safety-oriented attitude is the most important factor in shooting safety. Thus, you should focus not only on learning the rules, but also on developing the type of attitude that ensures that you will follow them at all times."

In other words, safety is the practice of being safe, which you should do because it’s important and, thus, safe. Got it!

Oh, and there was something else about how you’re not supposed to operate a firearm under the influence of recreational drugs, prescription narcotics, depressants, or stimulants. But even with my Adderall, I was having trouble paying attention to the stale mechanical language in the video.

And there’s no way that it could be safer and legally required for me to be off my medication when shooting a gun ... right?

After the video, the instructor explained the basic local laws to us.

He was a heavy-set Italian-American man in a matched grey jumpsuit with a thick North Shore accent, and he did not hesitate to add the disclaimer that he was not a legal expert and that if anyone had any real questions about gun laws in the state of Massachusetts (which he only ever referred to as "Stupid-chusetts" and made us repeat that un-clever nickname back to him several times), they should consult a lawyer.

He explained that there are three different kinds of gun permits you can get in Massachusetts: the firearm identification card (FID), which limits the user to a rifle or a shotgun; a restricted license to carry (LTC), which allows for handguns and semiautomatics as long as they’re kept in the home or in the trunk of your car; or an unrestricted license to carry (LTC), which allows you to conceal-carry anywhere you’d like.

As for how to get each of these licenses? That’s where things get a little more complicated because it all depends on the laws of the town in which you reside, not the town you’re in when you’re carrying that gun. And when pressed on the details of what happens when, say, a Kentucky resident with a conceal-carry license shows up in Boston, the instructor just told us to repeat: "Stupid-chusetts."

For the most part, the instructor seemed to be less concerned about gun safety or etiquette than he was in helping us to not get arrested.

"You have to cover yourself," he explained. "Remember: It’s your gun. No discharging the gun within 150 feet of a home or a highway. So if you see Bambi running across the highway, you do not go over and start shooting at her. Everybody understand?"

He then reminded us that we cannot exercise our right to bear arms while in prison. In general, "exercising our right" did seem to take priority over, erm, anything else about guns.

While the instructor did insist that we do our best to follow all laws and signs that restrict us from carrying a gun with us into certain places, he also made it clear that this was stupid, even though it was the law. "Picture your kids in a classroom right now, some maniac comes through and starts shooting at everyone. There’s no such thing as shelter."

As if right on cue, he said, "The only thing that stops that guy is a gun. So they need to change that law so that teachers can start carrying guns. Everyone should be carrying a gun. If they haven’t realized that now, something’s gonna happen and they will. 'Gun free zones' do not work. They only bring the maniacs in."

Then he sighed and conceded, "But if you do see a sign that says 'no guns allowed,' it’s best to just obey the rules, OK?"

Perhaps the most interesting thing I learned that day was that it is, in fact, illegal to own a grenade launcher in the state of Massachusetts.

This is part of the reason that Massachusetts is considered such a strict state for gun owners: Even when you have obtained that license to carry, there are some extra rules about what you can and cannot own thanks to a statewide ban on "assault weapons."

Our instructor explained that the state restricts the length of your gun barrel, for example, and has an outright ban on high-capacity magazines of more than 10 bullets (which rules out anything made after September 1994, and these laws have been tightened even more since I took this class).

To be fair, there’s no clear evidence that banning semiautomatic weapons affects gun violence rates either way. In criticizing this law, the instructor did make a valid point: If someone is intent on murder, it’s not going to make much of a difference whether they have a 27-inch barrel or a 29-inch barrel.

But the rest of the class seemed particularly appalled at the idea that the government would dare impede their constitutional right to a grenade launcher. In fact, there was some brief confusion about which amendment, exactly, guaranteed our right to a grenade launcher. The instructor assured us that it was the Second.

10 weeks later, I checked off my next "gun owner" box at the Boston Police headquarters, where I swapped stories about day drinking during the Boston Marathon with an officer while she rolled my fingerprints.

That’s another fun detail about Massachusetts’ gun laws that you won’t find in most other states: You have go down to the police station and meet with an officer for an in-person background check. There’s no mandatory waiting period for this — you could feasibly show up the very next business day after you’ve taken your safety course — but since I’m a resident of Boston proper, things were booked up pretty far in advance.

One officer told me that it used to take two to four weeks to make an appointment in Boston. But ever since President Barack Obama announced his executive plan in January 2016, the phones had been running off the hook with residents who were eager to get a gun before the government took that right away from them entirely.

They said they were processing upward of 30 new LTC requests per day, and a surprising amount of them were from 21-year-old college students who were eager to accomplish this particular rite of passage. Car at 16, gun at 21 — for some people, that’s just how it goes, the officer said.

The actual interview and background check process was … fairly simple.

My small talk and banter with the licensing officer was surprisingly delightful. She explained to me that the Boston Police Department isn’t interested in preventing people from exercising their Constitutional right to bear arms. They just want to make sure that those who are armed fill a very basic and mostly objective criteria of competence and character.

What this meant was a few basic questions: Had I ever been convicted of a felony or violent crime or anything involving alcohol, narcotics, or operating under the influence? Had I been dishonorably discharged from the military, or had I ever been the subject of a court-sanctioned restraining order? Had I ever been committed to a hospital or institution for mental illness or substance abuse?

The formal part of this questioning lasted all of 15 minutes. I wrote "personal safety" on the official paperwork as my reason for obtaining an LTC, and that was good enough; no questions asked.

After the officer took my photo — and after I approved of the webcam-quality mugshot that would appear on my physical license — I asked what would happen if I had answered "yes" to any of the necessary questions. She said that some of them were dealbreakers while others simply required a written explanation and subsequent fact-checking.

I was surprised to learn that anyone who had ever been imprisoned for operating a motor vehicle while under the influence was banned for life from obtaining an LTC in Massachusetts. Felonies, restraining orders, and other situations, however, were evaluated on a case-by-case basis.

This might sound concerning, but the officer made a valid point in her explanation: People do dumb stuff all the time, and we’re all human, so you shouldn’t lose your rights just because you were a stupid high school senior who got caught with some pot or a stolen candy bar.

The only trick was, and still is, figuring out where to draw the line. Unfortunately, there's no objective criteria for what causes gun violence — and even if there was, the government wouldn't be allowed to find it. It would technically be discrimination if we didn't allow innocent people with psychiatric conditions (or disabilities or brown skin) to exercise their Constitutional rights. And it's not the job of the police to pass moral judgment on every would-be gun owner — nor should it be.

So that was that, I guess.

Then, finally, I ended up on Moon Island four days later, at the Boston Police shooting range, to try to pass a target test even though I’d never shot a gun before.

That’s the other thing Boston has that the rest of Massachusetts doesn’t: a mandatory shooting test. If I lived across the river in Cambridge — or in any of the 36 states that recognize that Utah gun license — I could legally get my hands on a firearm without ever actually touching one. But as a resident of the city of Boston, I also had to prove a bare minimum basic competency with a firearm before they’d let me buy one for myself.

At one point during my test, one of the range instructors saw me struggling to steady the .38 revolver in my hands, possibly because I had never held an actual gun in my hands before that morning. (And also I wasn’t on my Adderall because it’s illegal to operate firearms while under the influence of any kind of medication.) He walked over to me while I was reloading and offered some friendly advice. "Focus on the sight, not the target," he said. "Don’t pull the trigger, squeeze. Just breathe, relax, and keep it steady."

I did what he said — or tried to, anyway. Then I heard a loud pong come from somewhere near my target paper. "That was a pole," the instructor said. "You’re supposed to hit the target. Not the pole. And what’d my pole ever do to you?"

Oops.

That first time I took the shooting test was my first time handling a gun. 14 of my 30 bullets didn’t even hit the paper, let alone the target in the center of it.

In order to pass, you have to score a minimum of 210 out of 300 possible points on a standard target with rings for eight, nine, and 10 points. If you fail the first time, you can try again within two weeks; and if you fail the second time, you have to wait six months to try again.

They wouldn’t even tell me what I scored the first time around because it was so embarrassingly low. But they did make sure to tease me about losing to a girl — as it turned out, the only woman in our five-person group got the second-highest score.

Passive-aggressive sexist bravado aside, the test administrators were still surprisingly encouraging. They said they were confident I would pass the next time as long as I was relaxed and focused.

"We want everyone to pass, but if you can’t do it, we can’t pass you," one of them said as I left.

"And you know, if you’re close but not quite there, we’ll bump your score up for ya. We’re nice like that," said the other.

"We don’t actually do that," said the first one, with a glare.

When I returned two weeks later, I managed to score 256 points out of a possible 300, making me the highest sharpshooter on the range that day.

All I had to do was relax, take my time, keep both eyes open on the gun sights, and squeeze the trigger when I felt ready.

It might sound silly to enforce that shooting test requirement if someone like me can pass with flying colors the second time around. But I’d counter by saying that it taught me how to respect handling a firearm, which could make a difference for the hundreds of people who are killed and the tens of thousands more who are injured each year by "unintentional" firearm incidents. And frankly, that sounds a lot safer to me than letting any ol’ American walk into a gun store and leave with an M82, having never so much as ranked a high score on Duck Hunt beforehand.

As the licensing officer explained to me before I took (and re-took) the target test, only about 1% of applicants actually fail on both tries — not because of an inability to hit a target, but because they displayed dangerously questionable behaviors or attitudes on the range. If they acted like they were in a Western or a Quentin Tarantino film, for example, the officers on Moon Island would call up the licensing department and say, "That guy? No way." Even if they did ace the test.

That might be a bit subjective, but it's also a pretty low bar, so I'm totally OK with it.

So that's how I, Thom Dunn, someone with a mental disorder and who tends toward impulsiveness and distractibility, was granted a license to carry by the state of Massachusetts.

In these highly specific circumstances, a successful gun licensing process like the one in Massachusetts takes about as much time as it does to get a mental health diagnosis or to find an available therapist — about six to eight weeks if you’re lucky and up to six months if you’re not. And that’s in one of the country’s largest hubs for medical and life sciences. Most other states have fewer health care options and looser gun requirements.

And that's really the crux of it: Once you have a gun license — if your state even requires that much — you can buy a gun, and you’re good to go. $500 will get you a decent semiautomatic pistol and a box of bullets.

Mental health care, on the other hand, is an ongoing treatment. It’s not like a cold or a broken leg that mends over time. You have to keep up with prescription renewals, with therapy, and so on. You might learn to manage it over time, but it never really goes away. And when you're treated like a leper or made to feel like you're broken or weak just for seeking help — which tends to happen in this country — that only serves to make the problem worse.

I embarked on this whole journey because I was fed up with the link between guns and mental health. And now that I have a gun license, I'm still fed up with it.

Before I got my license to carry, I wasn’t a big fan of guns. And to be fair, I’m still not.

But I also have a whole new understanding of just how complicated the gun violence issue really is and how hard it is to determine who can or can't have a gun.

Blaming violence on neurological conditions like ADHD or schizophrenia or bipolar disorder is about as ridiculous as saying, "It's not guns! It's Fridays!" Sure, there's been some overlap, but not enough for us to make any useful conclusions about it. People with mental illnesses are fully capable of leading happy, healthy lives, and their decision-making processes aren’t necessarily affected by their conditions. (And if they are, it doesn't usually manifest as flying fits of violent rage.)

But the question still stands: How do we stop guns from getting in the hands of would-be killers?

After learning how to handle a gun, I am more comfortable with their general existence, and I’m glad to have had the chance to speak with normal, rational human gun owners who, like me, were concerned about safety. Perhaps I shouldn't be so surprised by that last part — after all, 74% of NRA members agree on the need for stronger universal background checks.

But to fix this, we can't punish or restrict innocent people before they've ever committed a crime. What we can do instead is the bare minimum due diligence in making sure that those who do have access to guns are of sound physical and mental condition — regardless of whether they have a psychiatric condition.

I actually think that a system like the one in Massachusetts could be a good place to start for that, but I'm open to a dialogue.

(There's also that issue of states' rights, which enable people to legally obtain illegal firearms just by driving to another state, but that's a whole huge conversation in and of itself to table for another time.)

As much as we like to think of ourselves as rational beings, research shows that our personal perceptions color the way we look at the world — for better and for worse.

Unfortunately, our public discourse about guns tends to revolve around mass shootings, which only make up a fraction of the overall gun deaths in the country. Often, we ignore the evidence to the contrary and convince ourselves instead that anyone who kills another person has to be mentally ill. But "being a murderer" is not the same as having a mental illness.

These fears and perceptions are why some people do actually feel safer with a gun despite the mounting evidence to the contrary.

They're why we talk about "criminals" and "bad guys" with guns like they're a faceless, monolithic evil. They're why attempted suicide is a felony in some states but killing someone based on a subjective claim of self-defense is legal in others.

And they're why we keep wrongly equating gun violence with mental illness.

It sounds strange, but these perceptions are a natural part of "healthy" human brain function. However, they also contribute more to our continued gun problem than mental illness ever will because they prevent us from having a productive conversation.

Perhaps the biggest roadblocks in addressing our nation's problem with gun violence, then, are fear and a lack of empathy — on every side of every argument.

As we've seen throughout history, one bullet has the power to change the world.

But so does a single idea. And it all comes down to the difference between those two things.

Bullets are made for destruction, even when they're used in self-defense. But ideas can be used to create. And I think that's a much more powerful thing.

There's a lot of complicated ground to address around guns in America. But it all boils down to the fact that violence only ever begets violence. If we want to live in a safer, saner world, then we need to stop exchanging bullets and start exchanging our ideas instead.