Shortage of ADHD drugs continues as patients scramble to find medication

NEW YORK, Jan. 18 (UPI) -- A lingering shortage of medications to treat attention-deficit/hyperactivity disorder is forcing patients to scramble to obtain the prescription drugs they need.

The shortage of ADHD medications "has caused some strain on patients and families," Dr. Lisa Spector, division chief of developmental and behavioral pediatrics at Nemours Children's Health Florida in Orlando, told UPI in a telephone interview.

"They often have to wait for weeks, sometimes months, to get their medication refills, which is challenging," said Spector, who also is co-director of the Central Florida Behavioral Health Hub at Nemours. Such delays make it difficult for children with ADHD to function in school, she said.

ADHD is one of the most frequently occurring neurodevelopmental disorders of childhood, and it often continues into adulthood. Children with ADHD may have trouble paying attention and controlling impulsive behaviors or be overly active, according to the Centers for Disease Control and Prevention.

A child with ADHD might daydream, forget or lose things a lot, squirm or fidget, talk too much, make careless mistakes or take unnecessary risks, have a hard time resisting temptation, have trouble taking turns and have difficulty getting along with others, the CDC said.

Adderall in short supply

The ADHD medication shortage began with Adderall, an amphetamine, although it has had an impact on other stimulants, although generally to a lesser degree, Dr. Will Cronenwett, a psychiatrist at Northwestern Medicine in Chicago, told UPI via email.

Other stimulants include methylphenidate (Ritalin) and lisdexamfetamine (Vyvanse). They all have short-acting and long-acting forms, and have been impacted by the shortage, Cronenwett said.

The Adderall shortage occurred for several reasons: supply constraints, manufacturing problems and markedly accelerated demand during the pandemic, he said.

Cronenwett estimated that the number of adults taking amphetamines has gone up by about 15% since 2020, which led to a mismatch between demand and supply.

"Some people have had to make phone calls or trips to multiple pharmacies to look for places that had their medications in stock," Cronenwett said. "Other people have had to switch to alternative medications, and some people have had to go without."

He added that "people started to feel the effects about 2022, and things have rippled outward from there. As the supply of amphetamines started to dwindle, people looked to switch to other drugs similar to amphetamines, which then began to experience their own supply issues."

Pandemic cited

An original investigation published in JAMA Psychiatry last week revealed that prescriptions for stimulant and nonstimulant ADHD medications accelerated during the pandemic, particularly among young people and women.

In October 2022, the Food and Drug Administration officially announced a shortage of Adderall existed.

The study, prepared by researchers at the FDA, found that prescriptions for stimulant and nonstimulant ADHD treatments during the pandemic were much more pronounced than before the pandemic, possibly as a result of the number of adults working from home.

Overall, stimulant prescriptions for those 20 to 39 years old ratcheted up 30%, while nonstimulant ADHD prescriptions for this age group jumped 81%.

The medications also have become more accessible to a greater number of people, as the Drug Enforcement Administration began permitting clinicians to prescribe treatment for ADHD via telemedicine. These prescribing flexibilities are in effect through this year.

The shortage of ADHD medications is "pretty severe and it has been for the last 18 months or so," Manali Patel, a pharmacist who is the manager of retail/specialty purchasing and inventory at Vanderbilt University Medical Center in Nashville, told UPI in a telephone interview.

"Some of the strengths of the shortage medications don't have any available substitute options on the market," Patel said. "We've seen prescribing changes to accommodate for the strengths that are available at the time of need."

Production discontinued

But problems persist as "many manufacturers have discontinued production, so there are fewer manufacturers available to fulfill the demand," she said.

According to the Pharmaceutical Research and Manufacturers of America in Washington, D.C., which represents many of the nation's biopharmaceutical research companies, "drug shortages can occur for many reasons, with manufacturing quality issues being a primary driver."

PhRMA added that "other sources of drug shortages may include production delays and delays in receiving raw materials and other components from suppliers, natural disasters and/or other public health emergencies, as well as significant changes in demand to due to shifts in clinical practice."

For several months, retail pharmacies across the country have experienced shortages of ADHD medications, without an expected availability date for many of them, Trisha A. Jordan, chief pharmacy officer at The Ohio State University Wexner Medical Center in Columbus, told UPI via email.

"Switching medications can have an impact as patients often have found a specific medication that works best for them," said Jordan, who also is assistant dean for medical center affairs at The Ohio State University College of Pharmacy.

Possible alternatives

"We try to offer as many solutions to our patients as possible if alternatives are available, so they do not have to go without medication."

If a different strength of the same medication is in stock, the pharmacy offers to obtain the provider's approval to change the strength and quantity to fill the same total daily dosage, Jordan said. For instance, if the 30-milligram strength of Adderall is out of stock, but 15 mg. is in stock, the patient can take two tablets.

"If there are not alternative strengths, we recommend that the patient reach out to the provider as soon as possible to discuss alternative options that are available so they don't have to go without medication," Jordan said.

But Spector, who also is a professor of pediatrics at the University of Central Florida College of Medicine in Orlando, said part of the difficulty in managing this shortage stems from "pharmacies not always being forthcoming in telling patients and providers what other formulations of stimulants they have in stock, as it is a controlled substance."

"When we asked why they will not tell us or the families what stimulants they have in stock, pharmacies have told me that they fear that if they say out loud what stimulants they have in the pharmacy, it might prompt people to break in to steal them," Spector said.

"They have told me they have a policy against telling people what stimulants they have in stock."

At Ohio State, Jordan noted that "the pharmacy team has dedicated staff focused on medication shortages and sourcing. Medication shortages cause significant strain on the healthcare system, pharmacies, patients and providers."