For a long time, Nicole Foss couldn’t even get behind the wheel of a car without taking medication.
“It just seemed too risky,” she said.
Ms. Foss is one of millions of people diagnosed with attention-deficit/hyperactivity disorder in the United States. Without her medication, she says, it affects her ability to make “rational and logical” decisions. She’s also one of those affected by her nationwide ADHD medication shortage, a problem that could last for years.
The shortages include Adderall, Concerta, Ritalin and other medications.
“This is the biggest logistical burden for the most unbearable,” said Foss.
Foss, 24, from Laramie, has been on ADHD medication since third grade. But federal regulations still require people like her to go to pharmacies for 30 days of medication each month.
“I understand why [the regulations] The rate of abuse is high despite the well-established,” she said. “On the other hand, it makes it very difficult for people to get the help they need.”
Foss knew that medicines were in short supply because his parents worked in pharmacology. Medications dwindled and Foss had to get through several weeks without his regular drug Concerta and on caffeine, she said.
“I had headaches and things like that,” Foss said. “Withdrawal symptoms aren’t the worst. You can counteract them with caffeine. I did.”
She had applied for accommodations under the Americans with Disabilities Act, which also took time and energy.
Since then, Mr. Foss has lost his job and his health insurance is in jeopardy. She couldn’t afford medicine without her insurance.
At 24, she was able to join her parents’ health insurance. But her parents’ insurance company doesn’t operate in Wyoming, so Ms. Foss has to drive to Fort Collins, Colorado, to buy the drug. She now makes this trip on a regular basis and hopes that the pharmacy in her doctor’s office has medicine that works for her. For now, she’s taking a few metadate pills each day, and she hopes the old medication will be available again soon.
“I’m just tired,” she said.
Over the past 18-24 months, many people across the state and across the country have been affected by these shortages. Unclear. More medicines could be affected in the near future, but new shortages are expected, and finding affordable generics could become even more difficult.
behind the counter
Foss isn’t the only one to be dissatisfied.
Matthew Meyer, owner and president of the Wyoming Pharmacy Association, recently said a patient “exploded” at Hospital Pharmacy West in Sheridan after employees failed to provide him with medication. The patient already had to forward all information to Meyer’s pharmacy and was now unable to fill the prescription.
“Originally, we were able to supply [their medication] It took another three months and now it’s not available and we had to go look elsewhere,” Meyer said. “Your pharmacy…we are doing all we can. Shortages are hurting us too, so we are reviewing all available sources to get these medicines to our patients.”
For some people, these drugs aren’t just necessary to complete work or other tasks. People using higher doses may experience withdrawal symptoms. include Fatigue, sleep disturbance, depression.
People with ADHD like Foss don’t need these drugs to become highly capable “superheroes,” she explained, but to “get us to a level where we can function like most people.”
Meyer had heard that supply restrictions could be eased by late June or early July this year, but weeks later, challenges remain.
“There’s definitely a long way to go before we can say the supply chain is back to normal, fixed, or really close to being fixed completely,” he said. “but [there has been] It’s a step in the right direction. ”
how did we get here
Shortages are as complex as a chain of companies, regulations and drug distribution.
The Food and Drug Administration says: October of last year Some of the shortages were due to production delays and supply shortages, he said. Currently, FDA is reporting Adderall and similar “amphetamine mixed salts” are in short supply due to ongoing raw material shortages and historical demand.
Increasing demand itself is complicated. Expanding diagnostic criteria and general awareness may be contributing factors, especially for women and people of color. According to research Published last year. TikTok, Alone, perhaps We are promoting some of that interest.
Supply just can’t keep up. Beyond raw material shortages, the end of federal pandemic emergency measures has increased inspections of overseas factories. miss things in the meantime.
“Since it started last year, we have seen some factories have to close for various reasons, including hygiene and quality control,” Meyer said.
It could take six months or more to pass inspections again and resume shipping, he said. During the winter months, just getting your medication to a pharmacy can be a problem in Wyoming. frequent road closures.
Meyer added that even larger pharmacies could have problems, and that warehouses might ship drugs less frequently to pharmacies with lower revenues, such as rural Wyoming pharmacies.
“This is the biggest logistical burden for the most intolerable.”
Nicole Foss
“Especially Sheridan, our Walmart, Walgreens tend to run out of goods faster than we do,” he said.
At the same time, Meyer added, some pharmaceutical companies have stopped producing generic drugs because they are not profitable. Some generic drug manufacturers went out of business.
Finally, there is the complex and mind-boggling list of contractual arrangements and requirements between pharmaceutical companies, distributors, pharmacies, hospitals, brokers and insurance companies.
“Unfortunately, it’s very complicated,” he said.
The end result of these piles of agreements could make it more difficult for pharmacies to effectively address shortages and maintain solvency to ensure patients get the most affordable drugs, Meyer said.
what to do?
To curb shortages, companies like Teva, maker of the brand-name Adderall, say they are “manufacturing and selling in line with historic levels.” With increasing demand and increasing numbers of people moving to certain towns in Wyoming, previous levels of production are in short supply.
“You can appeal [to allocation amounts]”It’s pretty hard to win an appeal in a shortage,” he said.
In the meantime, Meyer said some people are turning to a similar ADHD drug, Vivanse, to replace Adderall, but even that may not be a reliable alternative in the future.
“At this point it’s just hearsay, but you know, we’re being told to be prepared for a Vivanth shortage,” he said.
Some of those who have relied on telemedicine to access these controlled substances since the pandemic began: Proposed Federal Rule This will require more in-person visits, but we are well on our way to implementing it. Late Until November.
As of Wednesday, Meyer said the new projections will have another 18 to 24 months of bumpy road ahead for those wanting to obtain more affordable generic versions of certain ADHD drugs.
Meyer says people who are short of needed medicines have options. One is to look at other pharmacies that may have contracts with companies offering more access at the time.
Another is to check with your pharmacy 5-7 days before you run out of prescriptions to allow time for your doctor to send your script to another location or approve any medication changes if necessary.
Phos does this regularly.
“Call me as soon as possible,” she said. “Get as much lead time as possible and do it monthly.”
Beyond those, Foss said, people need to start practicing coping strategies in case the medication runs out. Exercise can help, she says, but hitting a hard run every few hours isn’t always feasible.
And both Foss and Meyer talked about the possibility that ADHD medications would need to be switched, even if it took years to find the most effective one. Foss, she said, was lucky to have parents with whom she could discuss options.
“My mother said, ‘These are drugs that are pharmacologically similar to the drugs you take … You can switch to another drug with a different mechanism, but ask about these drugs first because they belong to the same family of drugs,’ says Foss.
Foss looks forward to an anxiety-free day with medication. But even then, she doubts, the regulatory burden, medical bills, busy clinics and stress of living with a chronic illness will remain.
“The supply shortage will eventually be resolved,” said Foss. “But I think the logistical nightmare of becoming someone who needs ADHD meds will probably only get worse over time.”
This article was originally published Wyo file Republished here with permission. Wyo file is an independent non-profit news organization focused on the people, places and policies of Wyoming.
