Spokane-area parents struggle to find refills of Adderall medicine and other ADHD drugs during national shortage

Feb. 16—More parents are struggling to find refills of Adderall medication and other drugs treating attention deficits prescribed for their children.

The national shortage also is affecting adults with ADHD, or attention-deficit/hyperactivity disorder, who rely on stimulant medications to help them focus.

Adderall shortages, which began in the fall, have led to tighter supplies among similar drugs as people try other options such as Ritalin and Concerta, said Dr. Brian Simmerman, a Spokane pediatrician. Parents worry that if children with attention deficits run out of their meds, they'll lose focus at school or for homework.

"That's been the challenge the past couple of months, is all of sudden people can't fill their normal ADD or ADHD prescriptions, and then kids may go a certain number of days without," Simmerman said. "It may make it harder in school, a bit harder at home. Families are left scrambling trying to figure out what alternatives they might have."

ADHD, one of the most common neurodevelopmental disorders of childhood, makes it difficult to concentrate and control behavior. Some people continue to have symptoms as adults. It affects about 9.4% of U.S. children ages 2-17, says the American Academy of Pediatrics.

In October, the Food & Drug Administration announced a shortage of the mixed amphetamine salts formulation, better known as Adderall, and it said one manufacturer, Teva, had intermittent manufacturing delays. Demand for the medication also rose during the pandemic, when Adderall could be prescribed online for the first time.

"Other manufacturers continue to produce amphetamine mixed salts, but there is not sufficient supply to continue to meet U.S. market demand through those producers," the FDA said.

Children respond well to common ADHD drugs and focus better in classes when families and schools partner to help kids stay on track, Simmerman said.

"There are a lot of children — adults as well — with attention deficits who do take medication and it makes a significant difference in their ability to pay attention, concentrate, complete tasks, stay organized, turn in work, and not have behaviors that degrade their ability to have positive relationships with peers and teachers," Simmerman said.

"They're very beneficial medications, and when these kids don't have them, it really strains all those parts of their lives."

Simmerman said he's worked with families as they face running out of ADHD drugs. Often, parents call around to check at pharmacies, and then his office moves a prescription. It might require changing a generic to a name-brand, he said, or a pharmacist suggests a version of the same medicine by a different company.

"For the medication itself, that's really been the strategy — can we switch the manufacturer, switch the dose a little bit, maybe find a different version of that medicine, or do we find a different medication at least for a short period of time until this is resolved?" Simmerman said.

About 80% of children with ADHD who are treated with stimulants improve on the right medication and dose, according to the pediatrics academy. Two forms include immediate-release drugs usually taken every four hours and extended-release medicine taken once in the morning.

Even among longer-acting versions, the drugs are effective within a day, Simmerman said. "They last a number of hours and then the effects are wearing off. They're not dependent on developing a long-term therapeutic level in the bloodstream."

Teresa Harberg, the Tacoma-based MultiCare assistant vice president of ambulatory pharmacy services, also is aware of worsening ADHD medicine shortages in the past two months. She regularly works with MultiCare's ambulatory retail pharmacy services in Spokane.

"The concern is that it's going to negatively affect the child; they're not going to be able to concentrate as well at school, maybe be more disruptive to the class," she said.

Harberg has heard various contributing factors to the shortages, including supply-chain and manufacturers' hiring issues, as well as a higher demand.

"What they say is occurring is that there were more diagnoses of ADHD during the COVID issue that raised the need for medications, and the manufacturers weren't prepared for that increase," Harberg said. "It was a significant increase over the past two years.

"All the amphetamine-type agents have a shortage right now," she continued. "It's hit and miss whether a pharmacy can get the meds from the wholesaler. Because of shortages with Adderall, some kids have been switched to different drugs. Those manufacturers weren't expecting an uptick either."

Although Harberg has heard of manufacturers trying to increase productivity to improve the outlook soon, "I think it's at least a couple or more months out."

Harberg also suggests working with providers and checking pharmacies.

"The pharmacies are working with their wholesalers," she said. "Maybe a local wholesaler doesn't have it, but one back East does. We're working behind the scenes, all pharmacies are, to get it in."

ADHD typically is diagnosed before age 12. Some adults are getting diagnosed, but with a history of struggling as a child, Simmerman said.

Most doctors prescribe either methylphenidate-based medicines such as Ritalin or Concerta, or a form of Adderall, he added, saying those options tend to work the best.

"Adderall is a stimulant, but it's a different mixture of amphetamine and amphetamine salt," he said. "It's got a few different components that are similar."

Simmerman said these drugs are thought to improve dopamine levels, a key neurotransmitter in focus, attention and decision-making.

The medications also seem to affect the brain chemical norepinephrine, along with dopamine, Harberg said. "It makes more of those substances available for the brain to use, which helps with focusing and the hyperactivity."

What's prescribed is specific to individual criteria, but some patients can switch from Adderall to a similar drug, Simmerman said. However, an alternative drug doesn't always work out.

Suggesting a stimulant usually prompts a common question whether it's counterintuitive, he said, "but it truly increases their ability to sit still, pay attention, stick to their work and not be so easily distracted."

Caffeine typically doesn't help. It can increase alertness but doesn't have the same dopamine effect and can lead to trouble sleeping well at night, Simmerman said.

Another strategy used by some parents is to give the medicine only on school days, and that often does work.

"It's actually not uncommon," Simmerman said. "Some parents already may have a plan where they don't give meds on the weekends. That may be a strategy if you're running out."