Earlier this year, reports began emerging in various cities in the United States, that a shortage of the drug Adderall was occurring. Just today, November 22, 2011, I was called by the first family to find that their pharmacy was out.
Adderall is the brand name for the drug amphetamine, which is used by many people to treat ADHD.
There are other forms of amphetamine available that are not in shortage (Vyvanse, amphetamine), and other related medications that treat ADHD (Ritalin, Concerta, Methylin, Metadate, Focalin), but for those being treated with Adderall, the shortage is of concern.
The reasons for the shortage are not entirely clear, not even what forces are driving it.
The manufacturer is making as many doses as it usually does, and doctors are prescribing it at relatively steady rates.
A curious feature of the stimulant drug market has emerged as this issue has been looked at. The stimulants are all variations of the street drug amphetamine, which is illegal to use without a prescription. Therefore, the use of amphetamines is tightly monitored by two major Federal agencies, the FDA (Food and Drug Administration) and the DEA (Drug Enforcement Agency). Each prescription for any stimulant is monitored and the government works hard to detect any trend towards illegal use. This is why prescriptions for stimulant medications cannot be called in and why, at the pharmacy, refills cannot be authorized.
As part of the government's effort to allow the use of legally prescribed stimulants but bad the use of illegally non-prescribed stimulants, the FDA sets a total amount of drug that can be manufactured in the US. That amount is set by the number of prescriptions. So, if in the US, say some number of tons of Adderall are prescribed each year, the FDA will allow the manufacturer to produce that number of tons, with some extra to make sure the supply meets the demand.
Officials at the FDA are clear that they have continued to allow the amount of Adderall to be manufactured that will meet the demand as defined by the number of prescriptions written. The manufacturer disputes this.
And so we have a situation in which families go to their pharmacy and find the pharmacy is out of Adderall, and cannot get more.
Possible reasons include:
- The government has it wrong, prescriptions are up and manufacture is not.
- The government has it right and there is enough being made but not enough reaches the drug stores
- A problem with distribution has occurred with problems in shipping or stocking causing the shortage
- Manufacturers are allowed to make enough but for some reason enough batches have gone bad to affect availability
- Manufacturers are making enough and distributing it well, but illegal use could be exploding, diverting the limited supply to those not prescribed the medication.
We do not know the reason at this time.
But, if you are on Adderall and find you cannot get the medication, try various pharmacies as your first step.
Consider mail order of the prescription as well.
If you are part of the Advanced Pediatrics practice, call our office to inquire about other approaches to helping your child with ADHD, including use of related medications that are not in shortage, non-medication options for therapy, and use of non-stimulant medications.
Dr. Arthur Lavin
Dr. Arthur Lavin
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