Monday, May 23, 2011

Stimulant Shortage: Conspiracy, Honest Errors or Over-Demand?

About 5.4 million children ages 4 to 17 have been diagnosed with ADHD; 66% take medications to control their symptoms. In addition, there are nearly 8 million adults diagnosed with ADHD the majority of whom take medications. Last year, that amounted to 152 million units sold of Adderall and Adderall XR, the extended-release version of the pill, 35 million units of Ritalin and nearly 702 million units of generic ADHD drugs with sales totaling more than $1.2 billion. The drugs are usually taken daily to control distracted thoughts and behavior well enough to participate in school, work and social life.

In early April, the U.S. Food and Drug Administration (FDA) added two major ADHD medications to its list of current drug shortages. The Pacific Northwest has been hit hard by these shortages due to a limited supply of the ʻactive pharmaceutical ingredientʼ (API) used to make brand medications such as Adderall XR, generically an Amphetamine Mixed Salt, and Metadate, a brand version of the generic Methylphenidate. The U.S. Drug Enforcement Administration (DEA) imposes quotas of this active ingredient on the manufactures. Why? There is potential for abuse especially among college students.

These current shortages have sparked a round of finger-pointing between Shire PLC the manufacturer and the DEA. Shire blames the shortage of branded and generic versions of its Adderall XR on DEA limits on the amount of product Shire can manufacture. The DEA, however, is deflecting the blame and issued this statement: “Manufacturers can request additional quota at any time during the year. DEA will review their request and provide additional quota, if warranted.” Adderall generated $361 million in sales for Shire in 2010, down 42% from 2009 because of the availability of cheap generic versions of the drug. Shire also supplies generic versions of Adderall that are marketed by Teva Pharmaceutical Industries Ltd. and Impax Laboratories Inc. UCB SA, a maker of generic methylphenidate, attributed its shortages to increased customer demand earlier this year.

Patients and pharmacies are having difficulty getting access to generic versions of ADHD drugs, forcing many patients to switch to more expensive branded drugs, switch to immediate release formulations, stretch their drug supply or take no drug at all. Brand-name drugs can exceed $200 a month if health plans cover only generics. While the FDA reports shortages like generic XR because of limited API put out by the DEA, ADHDers console yourselves by eating some alphabet soup. And stock up, because the end is no where in sight.

What to do? Here's some advice from Timothy MacGeorge, MDiv, MSW director of the National Resource Center on ADHD who posted the following information on the CHADD Leadership blog:

If you experience difficulty in filling an ADHD prescription due to this shortage, here’s what you can do:

  • Ask your pharmacist if the medication is available from another location, especially if you use a large chain pharmacy.
  • Contact the manufacturer to help locate a pharmacy that has your medication in stock (see the customer service numbers below). 
  • Contact the doctor who prescribed the medication to see if he/she has any samples you can use. 
  • Ask your pharmacist about the availability of other medications used to treat ADHD. 
  • As a last resort, discuss with your prescribing physician whether or not any of these available medications might be appropriate for you or your child. 

Pharmaceutical companies that produce Amphetamine Mixed Salts ER Capsules: 

  • Shire Customer Service Number: 800-828-2088 (select “Option 5” for assistance in locating a pharmacy in your area with product availability) 
  • Teva Customer Service: 888-838-2872 
  • Global Customer Service: 215-558-4300

Pharmaceutical companies that produce Methylphenidate HCL: 

  • UCB Customer Service: 800-477-7877 
  • Covidien Customer Service: 800-325-8888 
  • Sandoz Customer Service: 609-627-8500 
  • Watson Customer Service: 973-355-8300
As usual, I would love to hear  your comments, questions or suggestions so please use the form below to submit those. Next week's topic will be ADHD in the Workplace. Hope to see you then!

Monday, May 16, 2011

Welcome to my Blog- Support Groups

Welcome! This is my first blog entry for a new blog on adult Attention Deficit Hyperactivity Disorder (ADHD). I write this blog as a person with ADHD, as a parent of a teen-aged son with ADHD, oppositional defiant disorder and depression and as an Internal Medicine physician who treats and counsels adults with ADHD. Although there are many blogs addressing ADHD, most of them are written by lay people who may or may not live with ADHD, may not be raising children with this condition and who are not treating patients. In my blog I will review current scientific developments on ADHD and report other useful information that I gain from my own personal experience and from my patients, colleagues and attendees of my monthly adult ADHD support group meetings that I will tell you more about below. But first I would like to share a little bit about myself. 

As is typical, I was diagnosed with ADHD in my early 40ʼs shortly after my son who was seven at the time, was diagnosed with ADHD. I couldnʼt believe that I had gone through medical school and Internal Medicine/Primary Care Residency training without a notion of adult ADHD (ADHD was originally believed to be mainly a pediatric condition). I learned more about ADHD and its highly genetic transmissibility. I became aware that my life long struggles were also ones he was beginning to experience. And so began my journey thanks to my son, that leads me here today writing this blog. I'll share my thoughts on various aspects of life with ADHD through personal as well as professional insights.

Besides telling you about myself in this first post, I would also like to tell you about ADHD support groups. Support groups can be very useful for adults with ADHD; one does not feel so alone when meeting others struggling with many of the same issues. Attendees can learn from each other and be a source of information for local resources to other members of the group. My support group is run under the auspices of our local Seattle CHADD chapter. CHADD stands for CHildren and adults with Attention Deficit Disorder. CHADD is a national organization providing education, advocacy and support for those with ADHD. The Seattle chapter falls under the Northwest Chapter of CHADD. CHADD has other local support groups that you can learn about by by visiting the Northwest Chapter website.  ADD Resources is another organization located in Tacoma, WA and has local support groups for both parents of children with ADHD and adults with ADHD. Anyone is free to join my support group which meets the first Monday of every month at 6 PM on the second floor of Seattle Healing Arts (map/directions), which is where my practice is located. There is no charge for attending the group and sessions last for about an hour. Snacks and beverages are welcome. Next meeting is on June 6th; discussion to include the impact of ADHD in the workplace and on friendships. Dr. Wendy Woodard Psy.D.,ABDA will be co-moderating with me.

Check my blog if you think this kind of information may be of interest to you. You can post a comment- we all have something to contribute to this discussion! Please note that in an effort to avoid posts that are promotional or outright span, my blog is moderated which means I will have to approve comments before they are publicly available and this may take up to 24hrs. My next post is scheduled for 5/23/11 and will most likely address the national mixed amphetamine salt shortage. Thanks for stopping by!