In the spring, Liana Shaw-Robinson learned that her 11-year-old son, Madison, had run out of class to chase a squirrel in the school courtyard in Berkeley, California.
That’s not what her 6th graders normally do. But Madison wasn’t taking Adderall that day. Madison said the drug helps slow the brain “from 160 mph to 70 mph, like a car.”
Robinson said Adderall worked better for her son than other drugs used to treat attention deficit hyperactivity disorder. Adderall allowed him to be more calm and focused.
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“He really understood what relief was like,” Robinson said.
But for nearly a year, finding the drug—which Madison takes the generic version—has been difficult. Local pharmacies were out of stock, so I had to skip doses for up to two weeks in some cases.
The family is distributing pills for Madison, who recently turned 12, this summer so he can take them during the school year.
“I try to cope by having a few caffeinated drinks during the day and playing soccer in the afternoon,” Robinson said, adding that the strategy has helped her son manage his emotions. Told.
In July, the Food and Drug Administration announced a further shortage of ADHD drugs, adding a generic version of Concerta and two Vyvanse capsules to the list. And in August, the FDA and the Drug Enforcement Administration took the unusual step of issuing a joint memorandum acknowledging the shortage and asking manufacturers to increase production.
A representative for Takeda Pharmaceutical, which manufactures Vyvanse, said in an email that there was a temporary disruption to the supply of some Vyvanse capsules as “due to production delays, the company is actively working towards a resolution.” “We expect this situation to continue,” he added. Until September 2023. “
Parents and caregivers across the country spend hours each month searching for pharmacies that stock ADHD medications and asking doctors to transfer or rewrite prescriptions, but for many, the process amounts to a side job. . Some people pay hundreds of dollars out-of-pocket to buy name-brand medicines that, unlike generics, are not covered by insurance, although they are sometimes more readily available. Some children take similar, less effective medications or go months without medication at a time because their families don’t have the extra time or money.
ADHD is one of the most common childhood neurodevelopmental disorders, often characterized by inattention, confusion, hyperactivity, and impulsivity. Due to drug shortages, children across the country with the disease can fall behind in school during the spring, struggle with emotional control and struggle with relationships, according to interviews with doctors and parents. It is said that there were many. On the one hand, they all wonder, “Why is this happening and when will it end?”
“She couldn’t keep up”
Some parents say one of the most brutal aspects of the ADHD drug shortage is the collateral damage to a child’s self-esteem.
Kari Devink of Bowie, Md., said her soon-to-be senior high school daughter would lose interest in her schoolwork if the ADHD drug Concerta was no longer available under the name or brand name. generic version. She was usually a B. Her grades plummeted and so did her confidence.
“Once we were behind, we couldn’t catch up,” Devink said. “By the end of the year, we were just making sure she didn’t fall in her classes.”
Drew Tolliver, 12, of DeKalb, Illinois, usually takes the generic version of Concerta, but since February his family has had trouble finding it.
Taking the medication regularly “made me feel like I knew myself,” Drew said.
“I felt like I became a better person,” he added, “like what ‘me’ should be.”
His mother, Amy Tolliver, recently found the drug, but had to fetch it 40 minutes from the gas company, where she works 10-hour shifts six days a week. .
Amy’s wife and Drew’s second parent, Michelle Tolliver, said that in the spring Drew would refuse to go to class unless he had his medication. She and Amy Tolliver have sometimes forgiven and allowed him to stay at home.
“I hated to see him feel like a failure,” Michelle Tolliver said.
“It was held for 50 minutes”
ADHD medications are considered controlled substances, so patients must receive a new prescription every 30 days.
“I waited 50 minutes to speak to the pharmacist,” says Dr. David Grunwald, a child and adolescent psychiatrist in Berkeley, Calif. Talked about a recent phone call. I can’t spend hours on the phone.
In his practice, he said, long wait times at major pharmacy chains are becoming the norm.
“It feels like a game where you don’t know what meth you’re going to run out of each week or month,” he says. “It’s very frustrating.”
Kari Cyrus, M.D., a psychiatrist practicing in Washington, DC, wants to hire someone to check availability because she has to call pharmacies frequently. Now she tries to call all day, even when she’s making breakfast or walking the dog in the morning.
In a session with the patient, decisions must be made “how to combine different strengths and formulas to give the patient a normal dose, or as close as possible”, or to switch to another more available stimulant. There is something, she said.
Doctors say certain stimulants work better for some people than others, so changing medications can make treatment less effective. Even when switching from a name-brand drug to a generic drug, problems can arise. For example, a generic version of Concerta may not release the drug over time in the same way as the original.
Because of the shortage, Paige and Leo, who live in Northern California, are now giving their 7-year-old son Andy a drug called Metadate, which they say lasts only six hours. (Family members were asked to use their middle names to protect their privacy.)
This means Andy will need an extra dose in the afternoon during the after school program. Page said that sometimes staff forgot.
Then, “I got a call saying, ‘Your kid is out of control,'” Leo said.
Demand for stimulants soars
For children with ADHD who have problems with daily living, stimulants such as amphetamines (Adderall) and methylphenidate (including Ritalin and Concerta) have long been considered the gold standard of treatment by psychiatrists and pediatricians. Ta.
“These are some of the most effective treatments in psychiatry,” said Dr. Alecia Vogel Hammen, assistant professor of psychiatry at the University of Washington School of Medicine. “They changed my life.”
In recent years, the demand for these drugs has increased. Prescription stimulant use for the treatment of ADHD doubled from 2006 to 2016. And between 2020 and 2021, when the pandemic hit, the percentage of people who received prescription stimulants increased by more than 10% among some adults and teens. Analysis by the Centers for Disease Control and Prevention.
Some people may be misdiagnosed due to increased patient numbers and ease of assessment via telemedicine, and people who do not have ADHD but use drugs to be productive in school have raised concerns that stimulants for ADHD are being over-prescribed and abused by Or at work. But this is generally not the case. Studies show that girls, people of color, and people who identify as LGBTQ are often underdiagnosed and treated for ADHD.
Demand for ADHD medications has increased as both children and adults become more aware of the condition, doctors say.
Why are there shortages?
The ADHD drug turmoil reflects shortages of hundreds of other drugs, including generic chemotherapy, that have fallen prey to a downturn in the pharmaceutical supply chain.
Drug shortage expert Michael Ganio of the American Association of Health System Pharmacists said drug shortages are usually tied to a single manufacturing facility.
But in this case, according to the FDA’s online drug database, the ADHD drug shortage now involves multiple manufacturers, mostly generic ones, and has been going on since last fall. On the FDA website, the reasons given by each manufacturer can be as opaque as “regulatory delays” and “others.” Some say ‘lack of active ingredients’ or ‘increased demand’.
Some manufacturers give specific deadlines, such as “mid-August,” for when the issue may be resolved. But it’s unclear when it will start restocking pharmacy shelves.
Due to the high potential for abuse of controlled substances, the DEA places limits on the number of these drugs manufactured. However, according to government records, in 2022 amphetamine drug manufacturers produced about a billion doses less than they were allowed to make. In 2020 and 2021, we were unable to fully achieve our quota.
When asked for details about which companies have not met their quotas and whether any have requested increased quotas, DEA officials said details about each company’s quotas are considered confidential. replied.
“The fact that there is no information is just as frustrating,” Ganio said.
Emails to pharmaceutical companies that are currently in short supply of ADHD drugs offer little clarity on when the problem will be resolved. A representative for Teva Pharmaceuticals, which manufactures Adderall, said it plans to manufacture the full amount it is authorized to manufacture, although continued “unprecedented demand” could cause “intermittent delays.” said. Granules Pharmaceuticals, which makes generic equivalents to Adderall XR and Adderall IR, said it requested an increase in the DEA quota.
Another factor that could be causing the shortage is a $21 billion settlement brokered between three drug distributors and most states to stop the outflow of controlled substances such as prescription pain relievers. This has imposed new requirements on pharmaceutical companies. As a result, tens of thousands of drug orders, including ADHD medications, have been cancelled.
Irisa Bernstein, senior vice president of the American Pharmacists Association, said, “All pharmacy orders for controlled substances are subject to a higher level of scrutiny.” “It created a perfect storm.”
Susana, who lives in Tennessee, asked to be called by her family’s first name to protect her family’s privacy, but described the lack as a “nightmare.”
This year, she said, her 16-year-old son’s slow-release generic Focalin became unavailable. And his fourth quarter was a ‘roller coaster’ as they failed to score consistently.
“One week you’ll get 100s in class, but the next week you’ll have multiple zeros,” she said.
Susana said she was on and off medications over the summer to save money for the new school year, which starts Monday. That meant she could take extra time to find refills for his medicine.
“This morning I actually did a pill count to see how many pills he had left,” she said.
Now that he has a driver’s license, she intends to restrict him from driving, but she worries, “If he drives without drugs, will he be okay?”
Circa 2023 New York Times
