Similar concerns about the available supply of stimulant medication, such as Adderall, have been expressed by many adults with ADHD, as well as parents of children with ADHD, who have experienced frustration and delays in getting their prescription for ADHD medication filled.
“I live in Austin, Texas and have been on Adderall for about two years now. For the last four months, I have had to call several different chains of pharmacy stores here in my area -– Walgreens, a regional grocery store chain, and Walmart -– to find a pharmacy that can actually fill my script. I am due for a refill today and am dreading having to spend over an hour on the phone and then possibly drive across town to get my medication.” --35 year old male with ADHD
“Since this spring, I’ve had difficulty getting certain strengths of Adderall for my son’s ADHD. It’s continued and generic supplies are almost impossible. Fortunately, we can afford the name brand medications and are able to get those, albeit at a much higher price. However, it has been a problem since earlier in the year.” –-parent of a child with ADHD
“This spring I was on a generic brand of extended release Concerta / Ritalin. I went to fill my prescription and I had to call around several different pharmacies, as every one that I had visited was out or on back order. Luckily, by the time I was able to get into my doctor’s again, I finally had gotten my insurance and was able to go to a brand name medicine that was not in short supply.” –-Adult female with ADHD
“I live in Arlington, VA, about one mile outside of Washington, D.C. I had trouble getting my Adderall prescription filled earlier this year. I tried multiple Safeway pharmacies and CVS locations in Arlington and DC. It was also a pain because they don’t transfer between locations. It’s become better in recent months, although in October I discovered one CVS location that does not carry Adderall at all.” –-27 year old female with ADHD
Stimulants are the most commonly used medicine to treat symptoms of ADHD. There are two main types of stimulants -– methylphenidate (which includes brand name medicines such as Ritalin, Concerta, Metadate, Focalin, Methylin, and Daytrana), and the amphetamines (which include Adderall, Dexedrine, and Vyyanse).
The stimulants from the methylphenidate family all have the same active ingredient (methylphenidate hydrochloride) and are available in short-acting (also called immediate-release) and long-acting (extended release) preparations.
Stimulants from the amphetamine family all have versions or salts of the same active ingredient (amphetamine aspartate; amphetamine sulfate; dextroamphetamine saccharate; dextroamphetamine sulfate) and are also available in both short-acting and long-acting forms.
Short-acting stimulants are generally taken two to three times a day and last 4 to 5 hours per dose. Long-acting stimulants are usually taken once a day and last between 7 and 12 hours. Read about how stimulants work.
A Controlled Substance
Stimulants are very effective at treating symptoms of ADHD when used as prescribed and in combination with a comprehensive treatment plan. Methylphenidate and amphetamines are classified as Schedule II controlled substances, as they do have potential for abuse when used in a way other than as prescribed (e.g., crushed and snorted) or when used by someone without a prescription. The manufacturing and distribution of methylphenidate and amphetamines is, therefore, regulated by the U.S. Drug Enforcement Administration (DEA).
The DEA regulates the amount of stimulants (and other classes of controlled substances) that may be produced each year and made available for medical, scientific, and industrial use. The DEA also determines the quantity necessary for the establishment and maintenance of reserve stocks. This is all done through annual production quotas. The aim of these production quotas is to help ensure that there is not a surplus of controlled substances, which could lead to drug diversion and illegal use. Manufacturers may apply for an increase in their quota if there are circumstances that occur in the year that require an increased manufacturing rate.
FDA Drug Shortages Website
The Food and Drug Administration (FDA) posts information about current drug shortages as soon as they receive notice from manufacturers. Information is submitted by manufacturers on a voluntary basis. FDA cannot require firms to report the reason for shortage, duration of the shortage, or any other information about shortages. As of November 2011, several reasons are listed for the stimulant shortage, including an increase in demand, manufacturing delays, and supply issues with the active pharmaceutical ingredients. To learn more, go to the FDA Drug Shortages Website.
The American Society of Health System Pharmacists also tracks drug supply issues and lists current shortages in their Drug Shortages Resource Center. The website also includes information about the reasons for the shortage and estimated resupply dates.
From the Pharmaceutical Manufacturers
Matt Cabrey, spokesman for Shire Pharmaceuticals (the company who developed Adderall) explains that there are two versions of Adderall: instant release (a short-acting medication) known as "Adderall IR," and extended release (a long-acting medication) known as "Adderall XR." Shire owns only the "XR" version. There are also two "authorized generics" of Adderall XR that are manufactured by Shire and distributed by two other companies.
Cabrey notes that there had been some spotty distribution of the "XR" in early 2011. That issue has been resolved and there is currently no supply issue with Adderall XR. The "IR" is generic and there does continue to be a supply issue with the "IR" version. Shire no longer makes, owns, or distributes Adderall IR or any of its generic forms, reports Cabrey.
Though the increased awareness and diagnoses of ADHD can make it more difficult to predict consumer needs, Cabrey reports that this previous shortage had been due to a delay last year at the DEA in releasing extra supplies of the drug's active ingredients. Denise Bradley of Teva Pharmaceuticals (a generic pharmaceutical manufacturer) agrees that the DEA quota system has been part of the issue.
Marija Mandic, spokesman for Sandoz International (another generic pharmaceuticals company), says that Sandoz is aware that there are currently intermittent market shortages of dextroamphetamine and amphetamine. “We are committed to supporting the FDA to address this problem. Sandoz has no back order of generic Adderall,” reports Mandic. “We are working diligently to ensure our supply of these products meets demand, including discussions with DEA regarding our quota levels for these controlled substances.” Mandic stresses that the company remains committed to helping ensure patients have the ability to fill their prescriptions.
From the DEA
Barbara Carreno, DEA Public Affairs Officer, emphasizes that it is DEA’s mission is to ensure that there is an uninterrupted supply of controlled substances to meet the legitimate medical and scientific needs within the United States. She notes that there are, however, numerous dynamics that affect the supply of various products, many of which DEA does not control. She provides the following examples:
- Companies make business decisions regarding when they will manufacture a given product, how they will logistically move their products, and what they will sell to their downstream customers.
- Quantities of a particular product may be in short supply in one area of the country while a glut exists in other areas, but cumulatively there are sufficient quantities to meet legitimate need.
- Companies along the distribution chain may be restricted from purchasing from other companies due to contractual obligations.
- Additionally, companies vie for market share through sales of branded versus generic products.
“Through the quota process, DEA is able to monitor how much of a particular substance is in the pipeline and available to meet legitimate needs,” says Carreno. “When warranted, DEA can and does increase a company’s quota to ensure an uninterrupted supply.”
What To Do If You Have a Stimulant Shortage in Your Area
It may be hard to tease out all the issues that have lead to the current lower availability of stimulant medication. Whatever the reason, if you are an adult with ADHD or a parent of a child with ADHD who is on medication to help treat their symptoms, it is important to be aware that you may experience some difficulty in getting prescriptions filled. You may need to call around to multiple pharmacies to find one that has your medicine in stock. You can also explore mail order options, such as the pharmacy run by Drugstore.com
If you have concerns, be sure to talk with your doctor. There may be medicinal alternatives you can explore. "While stimulant medications are not necessarily interchangeable, a backup prescription for an alternative stimulant formula should be considered for patients who continue to have difficulties obtaining a particular medication to provide as little disruption as possible to their treatment regimen,” says Vatsal G. Thakkar, M.D., Clinical Assistant Professor of Psychiatry at NYU School of Medicine. Dr. Thakkar notes that medications very similar to Adderall are lisdexamfetamine (Vyvanse) and dextroamphetamine (Dexedrine). Other stimulants that could also be tried are from the "Ritalin" family, which include Concerta, Focalin, Metadate, and generic methylphenidate. Be sure to talk with your doctor about what options are most appropriate for your own situation.
Often, doctors may hesitate providing two different stimulant prescriptions to a patient at the same time. “In these situations, a physician can ask that the unused written prescription must be returned, or a patient can be given one prescription with the instruction that they can come exchange it for an alternative if they are unsuccessful in filling the first,” says Dr. Thakkar. “Unfortunately, this medication shortage has become widespread and lasted longer than expected so it will require unique interim solutions by prescribers and patients."
Barbara Carreno; email correspondence, November 8, 2011
Denise Bradley; email correspondence, November 1, 2011
Marija Mandic; email correspondence, November 4, 2011
Matt Cabrey; email correspondence, October 31, 2011
U.S. Drug Enforcement Administration, Office of Diversion Control website, Quotas - http://www.deadiversion.usdoj.gov/quotas/index.html
Vatsal G. Thakkar, M.D.; email correspondence, November 9, 2011