ADHD drug shortage stresses families during back-to-school season

By CNN

Published September 4, 2023 11:52 AM

CNN

By Meg Tirrell and Amanda Sealy, CNN

(CNN) — Earlier this year, Clara Pitts got the news she was hoping for: She had been accepted to her dream school, Brigham Young University.

It was a feat made all the more joyful for Clara and her family because of what she overcame to get there: a diagnosis with attention deficit hyperactivity disorder, or ADHD, and in the last year, difficulty accessing medication for it.

“After maybe one or two weeks of not taking my meds and realizing the negative effect it had on my focus, that’s when I started to get worried that I wouldn’t be able to get any kind of help for my college applications and for my senior year of schoolwork,” Pitts told CNN.

CNN reported on Clara’s hunt for her ADHD medication earlier this year. She was able to switch from Adderall to another medication, called Vyvanse, but that one has recently been hard to come by as well. Now, as she prepares to start her first year at BYU, she’s worried about navigating the shortages by herself.

“It’s just really scary not knowing if I’ll have consistency in my medication,” she said.

Clara’s not alone. There’s been a shortage of medications for ADHD in the US since last fall, when one manufacturer experienced delays, according to the US Food and Drug Administration.

But since then, it hasn’t improved. Eleven drugmakers are listed as making Adderall or its generic versions on the FDA’s shortages website, and while some say the medicine is available, others don’t foresee an end to the shortage until December.

“A lot of the young people that I’ve been treating have had difficulties getting their medications month to month,” said Dr. Warren Ng, a professor of psychiatry at Columbia University Medical Center who also serves as president for the American Academy of Child and Adolescent Psychiatry.

Without medication, many children with ADHD fail classes, are held back from going to the next grade, get sent to the principal’s office and have trouble doing homework, Ng said.

With treatment, he told CNN, “it can really change a young person’s life overnight. Suddenly they are able to do the work that they want to do.”

And it can dramatically affect their self-esteem, he said.

“I’ve seen kids who want to drop out of school, don’t want to continue with their educational path or drop out of college suddenly making the honor roll,” Ng said. And “instead of seeing, being seen as being lazy or dumb or slow, they can envision themselves really utilizing all of their mental, psychological and intellectual abilities to really see themselves for who they are, which is so much more.”

Back-to-school season is a particularly important time for families to be able to access medicines for ADHD, as some patients take summers off and it’s a time for them to get new prescriptions, said Erin Fox, a drug shortages expert at the University of Utah.

“It’s not clear if the drug companies are ready for this,” she told CNN. “We are seeing shortages of all the controlled substances used for ADHD.”

Because the medicines are stimulants, they’re controlled substances, considered by the government to have a high potential for abuse. That adds an extra layer of complexity in an already opaque system for the pharmaceutical supply chain since the Drug Enforcement Administration sets limits for how much of the substances the industry can make.

But in August, the DEA, in a joint letter with the FDA, said that last year, manufacturers collectively didn’t make as much as they were allowed to.

“There were approximately 1 billion more doses that they could have produced but did not make or ship,” FDA Commissioner Dr. Robert Califf and DEA Administrator Anne Milgram wrote in the letter.

The data so far for 2023, they wrote, “show a similar trend.”

CNN attempted to contact each of the 11 manufacturers of Adderall and its generics listed by the FDA. Only two, Teva Pharmaceuticals and Novartis’s Sandoz unit, responded. Both said they were making as much as they were allowed.

“We don’t know how many prescriptions are being written, how much product the companies are making and what the gap is” in terms of prescriptions unfilled, Fox said.

Data show more and more prescriptions have been written for ADHD medications over the past decade. The FDA and DEA said dispensing of stimulants rose by 46% in the US between 2012 and 2021.

And a report from the US Centers for Disease Control and Prevention in March showed prescriptions rose particularly quickly among young adults during the pandemic.

In their letter, the FDA and DEA said it’s “an appropriate time to take a closer look at how we can best ensure these drugs are being prescribed thoughtfully and responsibly,” encouraging the development of more clinical guidelines for diagnosing ADHD in adults.

The FDA also last week said it had approved several generic versions of Vyvanse.

Relief can’t come soon enough for students like Clara and others going back to school while dealing with the drug shortage. Ng said for some, the effects of not being able to find their medicines can be devastating.

“A lot of young people that I’ve seen have just given up,” he said. “They’ve been so frustrated with trying to get their medications to treat their conditions that they’ve either just felt that, you know, ‘It’s too difficult, maybe I shouldn’t go to college, or maybe I shouldn’t have this job.’ … It makes me very sad because it’s giving up on the dream for themselves.”

Despite these worries, Clara said she’s excited to start college, and plans to major in electrical engineering.

“Personally, I think that robots are really, really cool,” she said as she packed up her room at home. “And so I’m hoping that I’ll be able to learn how to make robots and do some kind of cool robotics in college.”

But she worries not just for herself, but for others also starting school with ADHD, and struggling to find their medicines.

“It’s really hard to know how many people, little kids, junior high kids, college students like me and even adults with their careers are now starting a new season of school and not having that available to them,” she said. “And I think time is going to tell whether or not we sink or swim as a collective ADHD community and whether or not this turns into a really huge thing with this new school year starting.”