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!