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Anti-ADHD Drug Shortages Hit Local Pharmacies

Over-prescription, abuse, DEA regulations, and major drug companies issuing more expensive brand-named drugs than generics are considered factors in the limited supply of cheap anti-ADHD drugs.

Local patients prescribed generic-brand anti-ADHD drugs may have had a frustrating time finding a drug store stocked with their specific medication.  

Shortages of generic anti-ADHD drugs have become endemic for local pharmacies: the CVS retailers in , , and all three locations in Danbury have been out of Dextroamphetamine, the generic brand of Dexadrine, for over a month, but some have other branded versions of similar drugs—such as Adderall and Ritalin—in stock, according to the pharmaceutical receptionists phoned. and are also experiencing shortages, as is . said that they did have Dextroamphetamine in stock, although implied it was in limited quantities. As of Jan. 4, the drug has been on backorder since early December, according to all the stores affected, and none had been given a restock date from the drug’s manufacturer.

Dextroamphetamine is notable for being one of the cheaper generic drugs, with a one-month supply of 30 5mg doses going for about $11, according to a Consumer Reports information sheet published in July 2010. A brand name of the substance, LiquidADD, costs seven times that amount for the same supply, according to Consumer Reports. 

According to a recent New York Times article, the shortage of ADHD drugs—specifically, the generic brands—appears to be a result of the Drug Enforcement Administration approving specified amounts of the drugs (because they are classified as a controlled substance) to be manufactured. These quotas are given to the Food and Drug Administration (FDA), which then passes along the restrictions to big pharmacy manufacturers. However, these manufacturers, while limited in the total number of amphetamines they can actually produce, can decide which prescription brands they want to create. For instance, the article states that Novartis creates ”both the branded and generic versions of Ritalin” and the company has “ensured that supplies of branded drugs are adequate while allowing generic versions to go wanting.”

Ease of access can lead to over-prescription, abuse

The DEA may have reason to issue these quotas. Dr. Barry Kerner, Physician-in-Chief of , said that many people abuse amphetamines and can acquire those drugs easily.

“Few doctors administer psychological testing for ADHD” and few doctors call patients’ previous psychiatrists for verification, which can lead to a “made-up history” which a person can use to acquire amphetamine prescriptions for years, he said. Many doctors could prescribe these drugs to a patient who may have read about and then feigned having the symptoms needed for ADHD diagnoses, using that information to obtain a prescription, according to Kerner.

If the doctor tries to tell a person whom they suspect does not actually have ADHD, the doctor runs the risk of losing the patient and the patient may just go and find another doctor for their prescription.

“Once you’re diagnosed with that it travels with you. People are often too busy to spend the time finding what the right diagnosis is. When people say they’ve been on this [amphetamine] for three years, and I say you don’t have ADHD, people get angry, get up and leave and go on to the next doctor,” said Kerner.

“It’s extremely easy to get the prescription for stimulants,” said Kerner.

Adults are the main abusers

It’s not just college kids who use amphetamines as ‘study drugs,’ either.

“There’s a whole area abuse that goes unnoticed,” said Kerner. “Soccer moms, who have to get through their day while doing 600 chores to run—they’ve got kids, benefits to go to, tennis in the morning, they’re running around the whole day” and might use stimulants to get through it, either by obtaining it through their own doctor or even using their children’s anti-ADHD drug.

“Then they might take benzodiazepines to go to sleep at night” he said. Benzodiazepines are a ‘downer’ drug which would be used in this case to counter-affect amphetamines ‘upper’ qualities.

While Kerner acknowledged that adolescents do abuse the drugs, “Most of the abuse is taking place in adults,” he said. “I think one of the reasons why there’s a shortage is because it’s being over prescribed....ADHD doesn’t begin in adulthood.”

Kerner noted that Provigil, a brand named drug that cost $18.55 per pill in August 2010, is a popular drug on Wall Street.

“If you’re putting in 14-hour days, some people resort to taking a stimulant to getting through the day,” he said. 

People who use pharmaceutical amphetamines habitually don’t experience physical withdrawal from the drug, but they are “habit forming and psychologically addictive” and in some cases patients may “crash, get depressed, get lackluster, and have no energy,” said Kerner.

Black market diversion and abuse

Perhaps because many people need to juggle multiple tasks and work harder to get ahead, or even just keep a job, the black market of amphetamines is thriving.

Kerner said there have been cases of people going to different psychiatrists in different states to obtain large quantities of the drug and sell them. He recalled reading about an instance where a person sold pills on Craigslist for profit. People sell them within their own social groups—a commonality in college—sometimes crush and snort the pills, and in rare instances melt the drug down and inject it, he said.

“We’ve had examples of abuse, people taking two, three, four times the amount as they’re supposed to take. We’ve had a kid with the correct [ADHD] diagnosis and abusing it,” said Kerner.

Dangers for patients without their medication

The Times article states that the Chief Executive of Children and Adults with Attention Deficit Hyperactivity Disorder believes “the drug shortages had become so acute that many patients were going untreated, increasing their risks of deadly traffic accidents and job dismissals.”

Kerner agreed, but only “for a small population of the people taking it. There are people who are truly ADD and ADHD, and these medications really help them,” he said. Amphetamines can also be prescribed for narcolepsy and occasionally used for some of its anti-depression effects.

(Ed’s note: For more insights into healthy living—and the dangers of the lack thereof—)

Amanda Pasciucco, MFT January 10, 2012 at 04:55 PM
Thank you for posting this article. As a marriage and family therapist, I do see many people that are prescribed with ADHD medication. What I am lucky enough to see is the before-and-after. Sometimes I have clients who can barely sit in a room for forty-five minutes, let alone function throughout their school day or jobs. In cases like these, I definitely see the necessity for stimulants to help them improve their quality of life. We are not talking about the "multi-tasking" mothers that were referred to in the article, but men and women who are working hard to compete within their schools and offices to keep up. Another piece of this article that is so unfortunate is the shortage that is going on with the generic brands. It is a shame that they are cutting back on generics and only stocking brand names. It just appears to be a money-making ploy to get people to spend because they are in need. Yes, ADHD medications should be a controlled substance. However, if you are going to continue making it, providing generics is essential for many of those who are in need of the medication.
Joe Doakes January 10, 2012 at 05:27 PM
Broadly speaking . . . if the free market could supply these prescriptions, at a profit without government interference, would any of these pharmacies or any of those that need these medicines be faced with the situation of not being able to get them? Does McDonalds ever runout of Big Macs? Why? "Obamacare" will kick in in 2014, unless we vote for the other guy, remember this when it is time to vote. Would you rather live in a world of plenty? Or one of rationing?
Craig Donofrio January 10, 2012 at 06:21 PM
The drug companies make the argument that you're making, while the DEA points the finger back at them. Big macs are not yet a controlled substance.
Cathy January 10, 2012 at 06:55 PM
Joe Doakes is correct. I just listened to a pod cast from a neurosurgeon who attended a workshop in DC this past November. There is much coming from this new healthcare bill, like this sort of rationing, that we have yet to be made aware of. I attempted to copy and paste it herer but ‘it’ wouldn’t permit it. None the less, we must make certain that what our lawmakers impose upon us is what we want. Put party aside and let the Constitutuon be your guilde. It is the only rule book America has, and for too long WE have all allowed our lawmakers too much rope...
Geoffrey Day January 10, 2012 at 07:14 PM
It's not that there isn't plenty of the ADHD drug available, and it's not that the drug companies can't make a profit on generics. It's just that they can't make as much profit as they think they're entitled to make. And what of the people who can only afford the generic version, if that? Well, I guess they can always get a job at McDonald's - that is, if they can stay calm enough to get through the interview. No pressure!
John January 10, 2012 at 07:22 PM
well written and certainly presents kerners very strong view that add/adhd is over-diagnosed. however, he seems to make alot of sweeping statements with little to back them up. is it possible his view is skewed because he is from silverhill? For example, stating that the shortage may impact a small number of people who truly need it - how can he know this? Or saying one doesn't get adhd as an adult - the diagnosis/understanding of this was even less understood 20,30,40 years ago and attitudes and care has changed. The diagnosis and treatment of ADD/ADHD is an area of debate within the medical profession- some say Kerner's view is similar to past discrimination against mental health issues. It would have been nice to see more of both sides of the coin. What was presented continues (in my opinion obviously) to place more emphasis on limiting potential abuse and less on the help it is providing patients. I don't think kerner's comments helped more appropriately balance that difficult task, but struck me as rhetoric of the worst kind.
Geoffrey Day January 10, 2012 at 07:42 PM
So, then, would you also say that the government is "rationing" marijuana and heroin and cocaine? Even so, too many people still manage to get just what they want. What would you call them - citizens in action against government intrusion?
Amo Probus January 10, 2012 at 07:48 PM
I suppose I may be old-fashioned. I worry that these drugs are prescribed too often and too easily. Just because a drug is available does not necessarily make it the drug-du-jour or make it right to use. Does the use of these drugs during childhood effect an adult in later life? Does he become 'addicted' and is he at risk for not 'learning' to control his inattention/urges? Boys are prescribed twice as often as girls which may reflect more on who is doing the diagnostics than on the child. The Brits disagree with the American approach. I say let's be careful and prescribe ONLY when other behavioral options are tried. I agree with Joe that the shortage may be contrived and may be repeated under Obamacare for other drugs. I think when we all finally begin to read and understand Obamacare's manifesto, we may be in for rude, expensive, game-changing government control.
Lee Bergeron January 10, 2012 at 10:05 PM
The problem is the government is going to make drugs to hard to get and people that truly need it will suffer.Those people might have to resort to black market to get them. Lee Bergeron
Eustace Tilley January 11, 2012 at 01:59 AM
Laws that prohibit or largely restrict the use of a particular substance are IMO attempts by government to ration the substance. Could be drugs, cigars, guns, ivory keyed pianos etc. These laws raise the barriers to acquisition but, where there is a will, there is a way to acquire the substance. "Illegally" to be sure but the consequence is rationing to the wealthy, to the fleet of foot or to the guy who is cunning or ruthless enough to figure out how to acquire the item. Same thought process applies to import tariffs - they too wind up rationing end use/ acquisition. Some would argue EPA and DOT regulations are ways to ration auto production - laws raise barriers to building your own car etc for example. Recall, JFK outlawed the importation of Cuban cigars; but only AFTER he sent his secretary down the street to buy up the smoke shop's supply....Picture a smoke filled room with inside traders... :)
Brian Kesselman January 11, 2012 at 12:58 PM
It is important to note that the shortage includes the brand and generic form form some dosages of Adderall. The drug manufactures say part of the problem is that one of the three companies that made the generic went out of business this year, shifting how scripts can be filled. Due to the DEA quotas, other companies cannot simply pick up the slack because they are limited in how much of the drug they can get and produce. The maker of the brand name has applied to the DEA to increase their quota to make up the difference, but even then it takes 3 months for new supply to become drugs in the pharmacy. Aside from the constraints that puts on the drug manufactures, Connecticut regulates this class of drugs: - Doctors cannot prescribe refills - or pre-date prescriptions more than 60 days - or call in the prescriptions or mail them. Patients must pick them up. - Script overlap is controlled, so patients must schedule an appointment to get new scripts within a small window to avoid running out (not taking shortages into consideration). Based on the current rules, these drugs are not easy for legitimate patients to abuse. It's unfortunate that the bureuacracy of regulations makes it more difficult for people who benefit from use. Note: Stimulant shortages have occurred in the past, and are not a result of a political agenda, but rather a long standing protection on a class of drugs similar to the restraints on prescribing morphine, codeine and oxycodone.
Trent N January 11, 2012 at 08:10 PM
We really need to regulate the DEA, or just get rid of them and the whole drug war. If people want to go to a doctor to get legal speed because it improves their work performance, that's fine. It's how our system is set up--people need to work more than we really should be. It's not a good system, I wish it would change, but it's just not. Both parties are at fault--the DEA for setting quotas, and the drug companies for maximizing cost-benefit at the expense of letting people dependent on their generic drug fall flat on their face. It's an ugly system.

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