Where Have All The ADHD Drugs Gone? Patchy Shortages Abound

The other day, my friend went in to a suburban Boston CVS to fill the regular prescription for Ritalin that helps her focus and keeps her attention deficit disorder at bay.

But the pharmacist sent her away empty-handed, saying that the store had not been able to get the generic drug in months and did not know when that would change.

“The pharmacist said that all the area CVS’s were out of it, along with Adderall and similar drugs,” my friend reported. Later, when she called around, she found odd clumps of supply: One store might have the generic but not the brand-name, or vice versa. Maybe, the pharmacist told my friend, she should try getting farther out of the city, away from the Boston colleges whose students generate high demand.

But it’s not only a college-area problem. There are patchy reports of drug stores around the state running out of ADHD drugs for children and adults (see our follow-up post here), and the FDA has just posted several new ADHD drugs on its national list of medications in short supply.

In Michigan, pharmacists say the shortage is among the worst drug dry-ups they’ve seen, according to this television report about disappointed customers who break into tears; and in Washington, D.C., some expect shortages to last until January at least, according to local reports.

Critical shortages of scores of important medications, including chemotherapy drugs, have been building for months, to the point that President Obama issued an executive order aimed at alleviating them earlier this week.

But those shortages tend to revolve around intravenous drugs with such low profit margins that manufacturers have little incentive to make them. (See NPR’s Dick Knox on the issue here.) They don’t tend to concern pills that, whether generic or brand-name, are blockbusters any way you look at them in a country where 9 percent of the children are diagnosed with ADHD.

So what’s happening? Has demand simply risen beyond drugmakers’ capacity as all those diagnoses have been made? On the FDA Website, rising demand is one of the reasons given for the shortages. But it may be more complex than that.

When I think ADHD, I think Dr. Edward Hallowell, a leading authority on the topic who writes books and runs treatment and education centers. Yes, he told me, over the last several weeks, he has heard from some patients that they have been forced to search from pharmacy to pharmacy for the ADHD medication Adderall.

“Just this morning, I changed someone’s medication because they were having such trouble finding it,” he said. “It seems crazy to me, and I don’t know what to tell my patients other than, I guess, ‘Go shopping,’” he said.

A drug representative for Shire Pharmaceuticals, a company known for ADHD medications among others, told him recently that the shortage is the result of federal quotas on how much of the drugs can be made, Dr. Hallowell said.

“I honestly don’t know, but I think that’s the answer,” he said, “and it just seems bizarre that they put a quota on it. I don’t understand the rationale behind that: If a medication is prescribed, it should be prescribed.”

Quotas? Aha, that dovetails with this BNET report from May, when extended-release Adderall was in short supply.:

Shire (SHPGY) is loving every minute of what it claims is a national DEA-imposed shortage of Adderall XR,* the attention deficit disorder drug taken by many of the 5.4 million kids who can’t sit still without it.

So Shire is blaming the Drug Enforcement Administration for limiting access to the amphetamines needed to produce ADHD drugs?

Well, the DEA is declining to accept the blame. I called DEA spokeswoman Barbara Carreno, who said that the agency actually sees it as part of its mission to maintain the flow of drugs for legitimate purposes.

She said that the DEA consults with the ADHD drugmakers annually to determine how much of the “active ingredients” — the amphetamines — they’ll need, and that they can ask for an adjustment later if needed.

“We don’t tell companies how much they can make of any given drug,” she said. “We come up with a quota and then they get their quota,” she said. “A lot of shortages happen when companies miscalculate how much they need of one dosage unit and over-commit some of their active ingredients like amphetamines to, say, 30 milligrams when doctors really want to give 10.”

She noted that the FDA Website shows that right now there are plenty of extended-release ADHD drugs, and only the faster-acting immediate-release drugs are in short supply. “That suggests there’s something beyond us,” she said. “If they have enough of one but not another, maybe it’s how they anticipated demand for their product.”

‘You can’t tell in advance which stimulant will help whom,’ he said. ‘And once you find one, you want to stick with it.’

Other possible reasons for shortages, she said: Recalls for quality purposes, theft, fire, strike. Also, sometimes a distributor will freeze out retailers who have poor track records on theft or “diversion.”

Hmmm. For a reality check, I turned to a trusted source, Dr. Daniel Carlat, a practicing psychiatrist, author and stand-out whistleblower about drug company money’s influence on psychiatry. On his Carlat Psychiatry Blog, he’s an astute observer of drug company tactics, such as their tendency to push patients onto new or slightly different drugs just as the old drugs are about to go generic.

He emailed: “It’s kind of complicated, and hard to tell how much of this shortage is a marketing ploy vs. an actual shortage. I tend to prescribe patients the generic dextroamphetamine sustained release as a good alternative.”

At this point, I’m ready to leave it at that, though if anybody has further light to cast on the source of these shortages, please let us know in the comments below. Here’s what we do know:

1) There’s a notable, spotty shortage of ADHD drugs around Massachusetts and the country.

I asked CVS spokesman Michael DeAngelis about it and he messaged: “There is a manufacturer’s shortage of ADHD drugs that affects all providers. In the event of a manufacturer supply issue, our pharmacists work with patients and their prescribers to try to take care of the patient with alternative medication therapies when possible.”

I asked about the confusing finger-pointing and he suggested I check out the FDA’s Website on shortages: “They cite 2010 and 2011 as record years for drug supplier shortages, so the ADHD situation is part of a larger issue,” he wrote.

2) It sounds like most people do manage to find the drugs they need or close equivalents. But this may be an unsettled time for anyone with prescriptions to fill.

The good news, Dr. Hallowell said, is that there are a number of stimulants that can be substituted for each other. The bad news is that a substitute may not work as well for a given patient.

“You can’t tell in advance which stimulant will help whom,” he said. “And once you find one, you want to stick with it.”

I asked if it was dangerous to simply stop stimulants if they run out. No, he said, “It’s just unpleasant. It’s like going without your eyeglasses.”

More: Voices from around the state on the hunt for ADHD drugs.

 

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  • Lisa

    I am a full-time student on Maine care who wasn’t even told that MaineCare was going to stop covering Adderall and I have been put on Vyvanse which doesn’t exactly work well for me. I have to be on this for 1 month before I can switch to something different. I have to attempt 3 other drugs before I can get a prior authorization for the adderall XR that worked for me for years after trying other things.  It is the only one that did not cause severe headaches and I am suffering because of this. There was a shortage here of the fast acting adderall in Cumberland County Maine and I believe there still is but, I was able to find my adderall XR. I don’t get it.

  • John

    That’s the price we pay for playing Rambo in other people’s countries. Everything is going to go to the dogs.

  • Jlewis

    Try NeuBecalm’d, an all natural supplement from Neurogenesis, Inc. at http://www.neurogenesis.com

  • Tom

    There are natural alternatives that work.  Now might be a good time to save your life and try one.  Take Adderall now and it’ll be Meth later. (It’s basically the same stuff).

    • Phillip

      This is true, I have used a natural alterantive for about 15 years, and it does so much more than fix my adhd.  It’s changed my whole life (most of my family too.)  I’d tell you the name of it, but then you would think I had a reason to lie.

      • Jlewis

        Phillip, what are you taking?

        • Phillip

          If I post the name of it publically on this forum all credibility is lost.  That’s just the way it is.  If you want to email me individually, I’ll share.  Phillip@yapt.com

  • http://twitter.com/foggyphils Holly Hitt Ezell

    To give a bit of perspective, in Charleston, SC my mom and pop pharmacy  trippled the cost of my adderall rx from ~$40 to $130. And after calling every pharmacy in the area, the only one that had any was Walmart who wanted $455! My Dr. is offering to change the RX to dextroamphetamine. Since the pharmacy says they “hoping” for some relief by January that’s probably what I’ll have to do. Sheesh.

  • adultADD

    To comment on that last part about going without ADHD medication, it can be more than just “unpleasant”. Patients can experience a number of side effects ranging from unpleasant to dangerous due to withdrawal. They include nausea, excessive fatigue, unregulated appetite, depression, hot flashes, cold flashes, heart palpitations, and suicidal thoughts. I experienced these symptoms when I stopped taking Adderall to participate in a sleep study. They were the worst days of my life and I couldn’t even function enough to go to work.

  • guest

    We live in a college town and adderall is often unavailable around finals time.  We have to travel 45 minutes to fill the prescription.  On another note, a couple of months ago we were told that the generic  prozak we had been using with great success was no longer available from that maker. The pharmacist substituted a generic prozak from another company and it was a nightmare.  I was told that there can be up to 15% difference in ingredients between companies of generics. Whatever was in the second generic created a bad reaction and we were told that we’d just have to go with the actual drug which cost $185 with the insurance discount as opposed to $10.  We have also had this experience over the years with adderall.  Has anyone else had this experience?  Does it have to do with China wanting to be in on the drug manufacturing business?

    • Jsandhjc007

      Yes, and worse. Generics are not the same because THEY ARE NOT THE SAME but some generic products, including medications, are better.  I wonder if your experience with Adderall caused the condition that led to the need for Prozac.  ADD drugs cause depression in those who do not have the disorder and those who do if the dosage is not very gradually increased over a long period of time.   Google Metadate CD and THERE IS NO GENERIC or substitute for this drug no matter what you are told by your pharmacist or insurance company.  Argue with them if necessary. The co-pay shouldn’t be more than $40.00 but the drug is extremely expensive. 

  • mom

    The generic version of Ritalin (which was the only version my insurance would cover for my son) was out of stock across the state last spring- and every month it was a new struggle to find the medication as we can’t get a 90 day supply by mail as with most “maintenance” medications, it can ONLY be dispensed in 30 day increments- and you can’t try to re-fill before that time so you need to repeat the stuggle every 30 days. Or insurance finally agreed to cover brand name-…. just wiating for that to run out also………

    • Jlewis

      Mom, I encourage to check out NeuBecalm’d from Neurogenesis, Inc.  It’s an all natural supplement that has helped many people as an alternative.
      http://www.neurogenesis.com

  • Guest

    I’ve heard that smaller ‘mom&pop’ pharmacies might have supply. Another alternative is having your doctor mail the prescription to Medco with prior authorization.

  • http://commonhealth.wbur.org/about/carey-goldberg/ Carey Goldberg

    I’ve also heard that because of the controlled-substance thing, you can only get the refill a day or two before the you run out — guaranteed major stress…