Update on the ADHD Medication Shortage: Profits and Abuse are the Roots

Update on the ADHD Medication Shortage:  

Profits and Abuse are the Roots

The New York Times on their first paper of the year, reveal what many have suspected, 

Image via Wikipediathe very real travails people are facing when trying to get a prescription filled for ADHD drugs appears to be due largely to drug companies trying to make more money, and people using the drugs illegally.









http://www.nytimes.com/2012/01/01/health/policy/fda-is-finding-attention-drugs-in-short-supply.html?pagewanted=1&_r=1&hp

The Setup

That ultimate source of the shortages comes from the fact that the major choice of drug, by prescribing doctors, to treat ADHD in the United States are the stimulants, amphetamine (adderall, vyvanse) and it closely related cousin, methylphenidate (ritalin, focalin, methylin, metadate, daytrana).  And, as we all know, amphetamine is a major drug of abuse and illegal to use without a prescription.

This means that the US government is firmly committed to preventing, stamping out, and prosecuting illegal use of all the stimulants.   This is why you cannot get a prescription for them called in to a pharmacy, or have refills at the pharmacy available over a year.

One strategy the government employs is to count the number of prescriptions written by doctors, and then limit the number of pills manufactured in the US to that number.  It actually makes sense.   It turns out that in the US, doctors write 51.5 million prescriptions for amphetamine or methylphenidate a year, so drug companies should make about 51.5 million prescriptions worth of the drugs, and if they do, there should be no shortage.

That is what they do, so why shortages?

Money

Everyone knows that you pay more for a brand name drug than the same drug marketed as generic.  But did you know many companies make both versions of their drug.  The Times noted two such examples.  Novartis makes both brand name and generic Ritalin.  Shire makes both brand name and generic Adderall XR.

Now, if you made the same drug in a very expensive brand and a cheap brand, and could only sell one total amount of the drug, would you rather sell the expensive or cheap version of the same thing?  Turns out Novartis and Shire have opted for the more expensive.  This creates a shortage of the generic, a serious one.

Abuse.

Think about the situation from this angle now.  The US only makes enough drug to fill 51.5 million prescriptions.  If only 51.5 million prescriptions are filled, fine.  But what if 100 million are demanded?

That's what happens when so many law students and medical school students take these drugs illegally to boost their grades.  Or when a large number of college undergrads do the same.  Or when millions of kids and adults take these drugs to get high or stay awake.

Bottom Line

1. There is a serious shortage of stimulant medication for ADHD.  The stimulants are amphetamine and methylphenidate.
2. The shortage comes from three causes:
• The drugs are under tight legal control to avoid abuse, so only a fixed number of doses are made a year
• Drug companies have chosen to make more of their expensive brand and cut production of the same drug sold as a cheaper generic
• Illegal use of the drugs is siphoning off supply
3. We find the use of stimulants problematic from a health point of view.  In particular, the long-term effect on the human heart from  use of stimulants is not proven to be safe.  There is a medication that actually calms the mind, called Intuniv, that is showing promise as a drug to be used for ADHD without shortage, and likely with less harm.

Dr. Arthur Lavin

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