Mysterious Adderall shortage puts ADHD patients at risk
theguardian.com
theguardian.com
As much as I hate to say it, this is fairly responsible behavior by regulators, who are likely betting that people without a real need will simply churn when it gets tougher to find some.
That said, it is sad that those with a disease that makes it difficult to plan and execute have to do exactly that to get their treatment.
The "telemedicine" apps that everyone derides have been infinitely helpful. I won't discount that they've made it easier for non-legitimate "users" to acquire adderall, but they've also been extremely beneficial for people like myself. Without them I would surely still be un-medicated and struggling much much more.
Even after being diagnosed it took me well over a year to make the "choice" to start taking adderall or to "become medicated" due to a mixture of things.
1. My inability or basically handicap that made it hard to follow through on multiple doctors visits in person, on site.
2. The worry about the perception of being an "adderall user"
3. Worries about possible addiction due to society's perception and *also* drug abuse in my family history
4. The lack of solid real information on what the process would look like. So uncertainty.
5. The fear that these telemedicine apps wouldn't connect me with an actual professional who would actually listen to my concerns (much like often happens in real life office visits where a doctor is stressed about time).
I started on 10mg twice a day over a year ago and I was asked if I wanted to increase my dosage, but I wasn't pushed to do so. It was an actual discussion if the dosage level was working properly, asked about my schedule, asked about the structure of my life and so on to determine if it was working as intended and not causing any ill-effects. I'm still on the same dosage a year later with no "pushiness" to increase my dosage. I definitely can't act like this isn't anecdotal, it is. But without this option I would be unmedicated. And with deliberate shortages I've had periods where I was forced to go without my medication and it felt like night and day. Which made me realize quite quickly just how debilitating ADHD had been for me for a long time.
So the idea of creating these deliberate shortages or doing away with telemedicine altogether for ADHD because of a lack of desire to find the appropriate regulation or measures that would be acceptable to allow it to continue to exist. It would be, and has been in some instances, extremely detrimental.
I can imagine, and am scared to think of, a situation in which I first lose access to my adderall prescription by a deliberate shortage, followed by a gutting of telemedicine providers. How can I with my "condition" exhibit "high levels" of executive function required to jump through many hoops because of others taking advantage of systems meant to help people like myself. Systems that make it accessible to receive treatment when without treatment I can't even begin to clean a small room because of this condition? The people who do take advantage of this situation will continue to do so. But I personally won't be able to. Or if I by some miracle can it won't last long until another "purge of the drug abusers" happens and a deliberate shortage renders me unmedicated for months at a time.
I need the stability because the instability of these systems impacts the people who need them the most. Otherwise it's lots of up and downs and it feels extremely hopeless.
edit: Ironically one of these shortages hit shortly after I got a new job and it was hard to execute which hit my reputation hard as a new hire. It's easy to say "i have a disability" but that doesn't magically make the requirements of business go away. And "federal protections" aren't absolute in the sense that you can get away with not executing to the required level. You'll be managed out on non-protected technicalities, as I was, that are still a result of the disability. And most people don't really want to have to get engaged in a lawsuit over these things and deal with the stress of being perceived as a "problem." At least I don't. I just want to be able to do my work, live my life outside of it, and so on without a ton of difficulty.
And another aside, the norms of the hiring process for programmers today are hard/demanding enough in terms of scheduling for "normal" people. It's triply hard for someone like myself without medication.
But doing it by deliberately limiting supply is a brute force approach that significantly impacts people who actually need treatment.
I think the belief that ADHD isn't a "real" disease permeates these decisions.
In my country, cancer patients are the biggest source of morphine used to make heroin by addicts. Yet cancer patients are not subject to any of the controls placed on people receiving stimulant based ADHD medications.
What I'm unsure about, is it because a cancer diagnosis is far more definitive? Or is it because it would play very poorly in the media if you made it far harder for all cancer patients to access the medication they needed, because a small percentage of them are selling it to junkies?
Either way, the controls around ADHD meds are excessive.
While the abuse potential for adderall has a stronger case, something like methylphenidate has a relatively low abuse potential and has been shown to be neuroprotective (unlike adderall which may be damaging long term). Requiring people to go through a semi-permeable ADHD screening and visit a doctor every 3 months for refills is unnecessary load on an already overburdened health care system (I'm in Canada).
Why are caffeine pills ubiquitous and accepted as a means to improve productivity, yet other stimulants are not? In my mind, this parallels the argument as to how alcohol is given a pass compared to other recreational drugs since it is already culturally accepted.
Because of their potential for addiction, and also we know that excessive usage of stimulants can have bad physical and psychological impacts.
You compared caffeine, well, that's not really comparable to stronger stimulants. Unless someone has committed murder five days into a No-Doze bender that I'm unaware of.
This isn't the same person as the student or office worker who prefers taking low dose methylphenidate to their usual two cups of coffee. If the drug was obtained illegally, many consider this to be misuse or abuse of the drug, and this is the caffeine/ADHD med cultural discrepancy I was pointing out.
So I suppose it is fair to ask: with the availably of black market stimulants, to what extent does restricting ADHD medication availability cut down on stimulant abuse?
And it's still not over; instant-release is just now, like this week, showing up in pharmacies here but extended-release - which the FDA nudged everyone toward in October - is still coming up short.
Let me help you. Telemedicine apps are prescribing stimulants like candy and half the country has a sweet tooth.
Everyone involved knows what’s going on, and people are getting rich, but the action is a little too hot. Pharma’s nervous about impending regulation so they’re chilling operations to avoid getting targeted in the crosshairs of the impending scandal.
One would think there's a better strategy.
> But last week, after reports that the company pressured its clinicians to prescribe medications for A.D.H.D., Cerebral received a grand jury subpoena from the U.S. attorney’s office for the Eastern District of New York, which is investigating possible violations of the Controlled Substances Act, according to a representative for the company. Cerebral has more than 200,000 patients.
> The investigation, which the representative said Cerebral intends to fully cooperate with, comes on the heels of accusations from former employees who said the company prescribed Adderall and Ritalin to treat A.D.H.D. without properly screening patients.
...
> Cerebral is only one of the dozens of mental health start-ups that took off in recent years. At the start of the pandemic, regulators relaxed rules around medical prescription of controlled substances, allowing clinicians to prescribe stimulants and other medications online without the need for an initial in-person evaluation, said Danielle Stutzman, a psychiatric pharmacist and spokeswoman for the College of Psychiatric and Neurologic Pharmacists, a professional organization of pharmacists.
> Those changes made it easier for people with A.D.H.D. to get access to treatments during lockdowns — but also opened the door for companies to prescribe and market drugs without the protocols that can accompany an in-person visit. The Wall Street Journal reported that Cerebral visits typically took only 30 minutes, during which time some clinicians felt pressure to prescribe stimulants.
Cerebral announced in May that they'd pause prescribing ADHD drugs,[1][2] then deleted the announcement by November.[3]
It's not the sole cause, as is the case most systemic problems - Teva Pharmaceuticals had a labor shortage for months that reduced production - but exacerbated a demand growth that had been fast since 2006, grew faster immediately before the pandemic, and then shifted in growth from children to adults under during the pandemic in line with the pandemic-inspired growth of telemedicine prescriptions.[1]
Teva's shortage is passing, but Alvogen, Rhodes Pharmaceuticals and SpecGX all remain short. Methylphenidates (Ritalin and Concerta) are also temporarily short as Adderall users switched off during the shortage.[4]
1: https://www.drugtopics.com/view/adderall-shortage-continues-...
2: https://web.archive.org/web/20220504153953/https://cerebral....
3: https://web.archive.org/web/20221120002710/https://cerebral....
Adderall is amphetamine. Anyone with or without ADHD (whatever that's even supposed to mean) can improve their concentration with α-methylphenethylamine and similar phenethylamines like methylphenidate ("Ritalin"). Question is if it's a good idea to make large parts of the population addicted to stimulants, especially children. Of course there are critics who have concerns and give pharma companies who're just out for a bit of profit a hard time.
How is that defined for a start? How is it measured?
I can have ADHD if I want amphetamine, the people diagnosing it and prescribing the drugs have obvious incentives to do so. That's the reason for the shortage in the first place. Same as with the earlier opioid epidemic. Should we presume that suddenly there was a massive increase in pain patients - or was it rather an increase in prescriptions?
Does the perceived harm that is (theoretically) minimised by this approach outweigh the harm done to people who genuinely need this medication?
Why would someone put out an article that scares patients who take this to be sane and productive and feel in control of one's time? Fearmongering to clickbait? Taking advantage of clinically confirmed impaired impulse control?