Telemedicine has made access to ADHD medications easier for many. But shortages have drawn attention to the problem of virtual prescriptions and his chain of supplies.
The explosion of telemedicine during the coronavirus pandemic has contributed to a surge in prescriptions for Adderall, helping to prepare for months of shortages. While struggling, regulators are trying to crack down on telemedicine prescriptions of abuse-prone drugs.
Prescriptions for Adderall, a stimulant drug approved to treat ADHD, have increased by more than 30% over the past five years, accelerating during the pandemic, according to data reviewed by The Washington Post.
The Drug Enforcement Administration suggestion Patients should be evaluated directly before receiving a strictly regulated class of drugs, including Adderall, because of their potential for abuse. The proposal had received more than 1,750 comments as of Monday, including patients who say it could jeopardize expanded access to life-changing medicines offered by telemedicine Includes many from providers.
Adelaide Robb, director of psychiatry and behavioral sciences at the National Children’s Hospital in Washington, said, “It’s not always easy to get to places where service providers are, so some people, especially not enough, have a hard time getting them.” Barriers may again arise for those in communities who have not. “We have people in our hospital who come from West Virginia for treatment,” she said of the ADHD patient.
Rob said he had hoped the shortage would be resolved earlier this year, but things are getting worse. You can’t even get Adderall from a hospital pharmacy,” Rob said. “This is a real crisis.”
Drug companies can’t keep up with demand for Adderall
Adderall is one of the best-known drugs for treating ADHD, a neurodevelopmental disorder believed to affect six million children in the United States that can cause inattention and impulsivity. is. The drug has also gained popularity in recent years among adults who recognize ADHD symptoms later in life.
In the past, people had to get a prescription in person, but pandemic-era exemptions have allowed providers to prescribe drugs after an online consultation.
Nearly 40% of all prescriptions for stimulants, including Adderall, came from telemedicine last year, up from less than 2% before the pandemic, according to analytics firm Trilliant Health. According to Trilliant’s, the increase in Adderall prescriptions is by adults between the ages of 22 and 44, a 58% increase between 2018 and 2022. analysis Nationwide for insurance claims. The company found that more adults were prescribed Adderall than were diagnosed with ADHD.
Sanjula Jain, Chief Research Officer at Trilliant, said: The discrepancy between prescriptions and visits could be partially explained by out-of-pocket clients whose visits were not recorded in the data, she said, raising questions about the rigor of ADHD assessments. “The threshold for getting a prescription may have changed,” she said.
In a statement to the Post, the Food and Drug Administration said the Adderall shortage was started by manufacturing delays but is now Growing consumer demand.
“Manufacturers are working hard to meet demand, and the FDA is supporting whatever we can do to increase supply.” the agency said.
Telemedicine has spurred virtual prescribing
Telehealth exploded in popularity when the pandemic began, providing a lifeline of care when many healthcare providers stopped in-person with patients. His DEA in March 2020 after the federal emergency declaration waived the requirement Face-to-face assessment for prescribing controlled substances that are regulated due to their potential for abuse. An industry soon emerged around virtual prescriptions, with online providers and pharmacies dispensing everything from benzodiazepines to ketamine.
When the state of emergency expires on May 11, the DEA released a proposed rule that would formally allow the prescription of controlled substances via telemedicine, but would impose new conditions on it. Adderall and other drugs deemed to have high abuse potential by the DEA require in-person evaluation prior to prescription.
Even as clinics reopen, many are drawn to telemedicine for its convenience and other benefits, with hundreds of patients and providers calling for a more flexible approach to DEA. increase.
For virtual meetings at home It also provides a new way to reach out to patients who are reluctant to open up, says Lisa Durette, an assistant professor and child psychiatrist at the University of Nevada, Las Vegas. “‘Show me your baseball trophy. Show me something you’re proud of,'” she said as an example.
Federal authorities have launched crackdowns on telemedicine providers who claim they are improperly handling controlled substances. The DEA announced in December that his Truepill, a retail pharmacy, improperly distributed As The Wall Street Journal reported, thousands of stimulants for ADHD are connected to telemedicine startup Cerebral. under investigation by the Department of Justice. Some pharmacy chains such as CVS and Walmart have stopped dispensing Adderall prescriptions from Cerebral and another telemedicine startup Done.
“Cerebral clinicians exercise independent and professional judgment in diagnosing and treating patients,” a company spokesperson said, adding that in May of last year, the company announced a new It added that it had stopped prescribing Adderall to the patient.
In a statement, Done said it understands concerns about Adderall’s abuse, but opposes restricting access. “We believe telemedicine is a powerful tool in breaking down geographic and logistical barriers to reach and serve more people,” the company said.
Truepill said it had stopped filling Adderall prescriptions via telemedicine, showing it had done nothing wrong. The company did not respond to a request for comment.
patient unable to fill prescription
Richard Molitor learns that customers at his pharmacy outside of Seattle who are trying to fill prescriptions for Adderall from telemedicine providers are being turned down at other pharmacies. Despite what he called “serious and time-consuming detective work,” he was unable to confirm from the available information that the prescription was from a legally required and licensed provider, I refused to fill them out.
Molitor said he felt bad for the patient. They are spending money on telemedicine subscriptions, he said.
Continued shortages have baffled suppliers, added stress to families, and the causes of shortages remain elusive. No one seems to have a complete picture of where breakdowns occur in the complex network of companies that manufacture Adderall to the pharmacies that dispense it. provide clues.
Prescriptions for various medications to treat ADHD increased by an average of 19% between 2018 and 2022, according to a Post review of data from healthcare technology company IQVIA. However, Adderall and its generic version saw the fastest growth in the last two years, up 35% during that time.
Timothy Wylens, an ADHD expert and director of the Department of Child and Adolescent Psychiatry at Massachusetts General Hospital, said the surge in prescriptions for Adderall, combined with supply chain shortages, was tightening the market and causing further turmoil. Said it was easier.
Industry experts say many pharmacies place monthly limits on the amount of controlled substances they can order from wholesalers. When patients start shopping to find pharmacies that have their medicine in stock, some stores quickly sell out, creating these “regional bottlenecks,” he said. increase.
“It just takes five or 10 families to do it, and that Walgreens supply has been exhausted,” Wilens said.
Wilens said the FDA expects the shortage to begin resolving in April, but experts say the shortage has dragged on for months longer than originally expected, so no timeline will be provided. I hesitate to
Lenard Adler, director of the adult ADHD program at NYU Langone Health, said the shortage was distressing for his patients.
“We had one patient who had to go to 14 pharmacies before he finally found a prescription,” says Adler.
Adderall Supply Chain Issues
The FDA announced a shortage of Adderall in October 2022. One of the major manufacturers, Teva, was reporting production delays. The DEA places limits on manufacturers to allocate active ingredients for controlled substances, but the agency says companies haven’t hit the limit in the past three years.
In a statement, the DEA said, “We are aware that the pharmaceutical industry is claiming an under-allocation of active ingredients for ADHD medications.” not.”
Justin Schroeder, global vice president of contract manufacturer and distributor PCI Pharma Services, said in February that manufacturers are still dealing with labor shortages and delays in raw materials from suppliers.
“We are in a highly regulated industry,” says Schroeder. “If Supplier A fails to deliver raw materials in a timely manner, we cannot call Supplier B and say, ‘We will switch orders.’”
in the two letters sent December and February, Congressman Abigail Spanberger (D-Va.) wrote letters to the DEA and FDA urging them to coordinate responses to the shortage. Mr. Spanberger told The Washington Post last week that he had written to both agencies to help Congress better understand the issues underlying the shortage.Spanberger said she and her Congressman Eric Swalwell (California Democrat) will discuss this issue with DEA Administrator Ann Milgram on March 6th.
Spanberger wouldn’t reveal details of the conversation, other than to say it was “a very productive call.”
Meanwhile, some patients resort to switching medications to avoid shortages. Attorney Maria Coppola, who lives in the Capitol, said she had been having trouble filling prescriptions for her 16-year-old son, Oliver, since last spring, and she had been going to various pharmacies around the city. She said she had to call.
“You get desperate and go insane,” Coppola said.
Coppola said he had to change the prescription and dosage for Oliver, who has been on ADHD medication for nine years. It was when I was able to find a prescription without any problems at my usual pharmacy.
“It was like a jackpot,” Coppola said.
Fenit Nirappil contributed to this report.
