Collateral Damage from A.D.H.D. Drug Shortages (2023)

This spring, Riana Shaw Robinson learned that her 11-year-old son, Madison, ran out of the classroom and chased a squirrel in the yard of his school in Berkeley, California.

Her sixth graders don't usually behave like this. But that day, Madison wasn’t taking his Adderall—a drug that, in his words, helped his brain “slow down from 100 mph (like a car) to 70 mph.”

Ms. Robinson said Adderall worked better for her son than other medications they were using to treat ADHD. After taking Adderall, he became calmer and more focused.

"He actually liked the look of Relief," Ms Robinson said.

but forAlmost a yearThe drug—Madison is taking a generic version—has been hard to find. Sometimes he had to stop taking the medicine for up to two weeks because a nearby pharmacy ran out of it.

This summer, his family rationed his medications so Madison, who just turned 12, could get them during the school year.

“We tried caffeinated drinks during the day and football in the afternoon,” says Ms. Robinson, a strategy that helped her son regulate his emotions.

In July, FDA Reports Further Shortages of ADHD DrugsUniversal version of the Concertoand two typesVivenceCapsules to list. In August, the FDA. DEA takes rare step, releases jointopen letterHe acknowledged shortages and urged manufacturers to increase production.

Parents and caregivers across the country spend hours each month looking for a pharmacy with ADHD. Stocking up on medications and asking doctors to divert or rewrite prescriptions is a process that many people equate to a second job. Others pay out of pocket for brand-name drugs that are sometimes more accessible but, unlike generics, are not covered by insurance. Some children end up on similar but less effective medications, or go months without them because the family doesn't have the time or money to spare.

One such condition is ADHD, which is often characterized by inattention, confusion, hyperactivity and impulsivitymost commonNeurodevelopmental disorders in childhood. Sick children across the country are falling behind in school due to spring drug shortages, and their relationships are often affected by difficulty regulating their emotions, according to interviews with doctors and parents. In the meantime, they all want to know: why is this happening and when will it end?

"She can't catch up"

One of the scariest aspects of A.D.H.D. Some parents say the lack of medication is the collateral damage to their children's self-esteem.

Kari Debbink lives in Bowie, Maryland, Her daughter, who is about to enter her senior year of high school, would lose motivation to finish school if she had ADHD, she said. There is no brand name or generic version of the drug Concerta. Her grades (previously B) plummeted - and her self-confidence went down with it.

"Once she came back, she couldn't catch up," Ms Durbink said. "At the end of the year, we're just trying to stop her from failing class."

Drew Tolliver, 12, of DeKalb, Illinois, usually takes the generic version of Concerta, but his family has been having trouble finding it since February.

As he continued to take his medication, Drew said, "I felt like I knew myself."

"I feel like a better version of me," he added, "like what 'me' should be."

His mother, Amy Tolliver, recently discovered the drug but had to spend 40 minutes picking it up from the gas company, working 10-hour shifts six days a week.

Amy's wife, Michelle Tolliver, Drew's second parent, said Drew refused to attend class this spring unless he was on medication. She and Amy sometimes give in and allow him to stay home.

"I hate seeing him feel like a failure," Michelle Toliver said.

"I waited 50 minutes"

Because ADHD medications are considered controlled substances, patients must fill a new prescription for every 30-day supply.

"I waited 50 minutes, waiting to speak to a pharmacist," Dr. David Grunwald, a child and adolescent psychiatrist in Berkeley, Calif., recently called for finding people with ADHD. Drugs for children whose mothers are chronically ill and unable to talk on the phone for hours on end.

In his practice, long waits at large pharmacy chains have become the norm, he said.

"It feels like a game where you don't know what stimulant you're going to run out of every week or month," he said. "It's very frustrating."

Dr. Kali Cyrus, a private practice psychiatrist in Washington, D.C., has to make frequent calls to the pharmacy, so she plans to hire someone to help her check for medication. Currently, she tries to be on the phone throughout the day, including in the morning while making breakfast or walking the dog.

When meeting with patients, she said, she sometimes has to decide "how to combine different strengths or formulations so that my patients get their normal dose -- or as close to it as possible," or switch to another, more readily available stimulant .

Doctors say switching medications may result in less effective treatment because certain stimulants work better for some people than others. Even switching from brand-name drugs to generics can be problematic.Universal version of the ConcertoFor example, their drug may not be released in the same way as the original drug over time.

Because of the shortage, Page and Leo, who live in Northern California, are now giving their seven-year-old son Andy the drug Metadate, which they say only lasts six hours. (The family asked to be referred to by their middle names to protect their privacy.)

That meant Andy needed to take an extra dose in the afternoon as part of his after-school schedule. Sometimes staff members forget, Page said.

When that happens, "we get calls like, 'Your kid is out of control,'" Leo said.

Demand for stimulants soars

For children with ADHD, psychiatrists and pediatricians have long recognized that stimulants such as amphetamines (Adderall) and methylphenidates (including Ritalin and Concerta) are useful for people who have difficulty with daily living. The gold standard of treatment with single-dose drugs.

"They're one of the most powerful treatments we have in psychiatry -- that's it," Dr. Alecia Vogel-Hammen is an assistant professor of psychiatry at Washington University School of Medicine. "You changed lives."

These drugs have been in high demand in recent years. Treat ADHD with prescription stimulants.Doubled from 2006 to 2016. During the 2020-2021 pandemic, the percentage of people with stimulant prescriptions has increased many-foldmore than 10%In some adults and teens, according to an analysis by the Centers for Disease Control and Prevention.

Rising numbers and the ease of assessments using telehealth have raised concerns for somemisdiagnosisAnd ADHD stimulants are often prescribed or abused by people without ADHD. But this drug is used to increase productivity at school or work. However, this is not the case. The study foundgirl,people of colorandConfirmed by those masquerading as L.G.B.T.Q.They are often underdiagnosed and undertreated due to attention deficit hyperactivity disorder (ADHD).

Doctors say the demand for ADHD patients has seen an increase in the number of medications due to growing awareness of the disorder in both children and adults.

Why is there a shortage?

Disease Drugs in A.D.H.D. Reflect Drug ShortagesHundreds of other types of drugsDrug supply chains, including generics, have come to a standstill.

Typically, drug shortages stem from a single manufacturing facility, said Michael Ganio, an expert on drug shortages at the American Association of Health-System Pharmacists.

But in this case, according to the FDA. ADHD drug shortages are now affecting some manufacturers, especially those making generic versions, and have continued since last fall. The reasons given by each manufacturer on the FDA's website are sometimes as vague as "regulatory delay" or "other." Others say "lack of active ingredient" or "increased demand."

Some manufacturers have already made concessionsspecific time frameThe time when the problem can be resolved, such as "mid-August". However, it's unclear when this will lead to restocking of pharmacy shelves.

Because of the high potential for abuse of controlled substances, the D.E.A. sets limits on the quantities of these drugs that can be produced. But by 2022, amphetamine makers will be producing about 1 billion less doses than allowedgovernment records. shenot fully meeting their quota2020 or 2021.

Asked for more details on which companies fell short of their quotas or whether any companies requested an increase, the D.E.A. official replied that each company's quota details are considered confidential.

"The fact that there isn't any information is even more frustrating," said Dr. Garnio.

Emails currently sent to drug manufacturers say there is a shortage of ADHD products. The medicine doesn't say exactly when the problem can be resolved. A representative for Teva Pharmaceuticals, maker of Adderall, said "unprecedented demand" remains, which could cause "temporary delays," but plans to manufacture the full doses it is authorized to manufacture. Granules Pharmaceuticals, which makes generic versions of Adderall XR and Adderall IR, said its D.E.A. increased. Require. speed.

Another factor that can cause scarcity is:Settlements exceed $21 billionThe bill, negotiated by the three drug distributors and most states, imposes new requirements on drug companies to stem the flow of controlled substances such as prescription painkillers. This has led to the cancellation of tens of thousands of drug orders, including for the treatment of ADHD. drug.

"All orders for controlled substances in pharmacies will be subject to greater scrutiny," said Eliza Bernstein, senior vice president of the American Pharmacists Association. "It's created a perfect storm."

This year, she said, finding extended-release generic Focalin for her 16-year-old son has become difficult. Since they haven't done it consistently, his fourth quarter has been a "roller coaster ride."

“One week he gets a 100 in his class, and the next week he gets multiple zeros,” she said.

Suzanne said he has been taking his medication over the summer so they can save for the school year, which starts on Monday. That means she has more time to find supplies for him.

"I actually counted the pills this morning to see how many he had left," she said.

Now that her son has a driver's license, she plans to drive less, but she worries, "If he doesn't take his meds and drives, will he be fine?"