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—)