Taking stock of the collateral damage of ADHD drug shortages
Kids missing medication face emotional swings
In the spring, Riana Shaw Robinson learned that her 11year-old son, Madison, had sprinted out of class to chase a squirrel through his school’s courtyard in Berkeley, Calif.
It’s not how her sixth grader would typically behave. But that day, Madison hadn’t taken his Adderall — the medication that, in his words, helps his brain slow down, “from 100 miles per hour — like a car — to 70 miles per hour.”
Robinson said Adderall worked better for her son than the other medications they had used to treat his attention deficit hyperactivity disorder. With Adderall, he was calmer and better able to focus.
“He actually had a taste for what relief could look like,” Robinson said.
But for nearly a year now, the medication — Madison takes the generic version — has been difficult to find. He has had to skip doses, sometimes for up to two weeks, because nearby pharmacies have been out of stock.
The family is rationing his pills this summer so that Madison, who recently turned 12, will have them during the school year.
In July, the Food and Drug Administration posted more shortages in ADHD medications, adding generic versions of Concerta and two types of Vyvanse capsules to the list. And in August, the FDA and the Drug Enforcement Administration took the rare step of issuing a joint public letter acknowledging the shortage and asking manufacturers to increase production.
A representative from Takeda Pharmaceuticals, which makes Vyvanse, said in an email that a “manufacturing delay, which we are actively working to resolve,” had created a temporary disruption in the supply of certain Vyvanse capsules, adding that “we expect this to continue into September 2023.”
Parents and caregivers across the country are spending hours each month hunting down pharmacies with ADHD medication in stock and asking their doctors to either transfer or rewrite prescriptions, a process many equate to having a second job. Others pay hundreds of dollars out of pocket for name-brand drugs that are sometimes more readily available but, unlike generics, are not covered by their insurance. Some children end up taking similar but less effective medications or go without medication for months at a time because their families do not have the extra time or cash.
ADHD, which is often characterized by inattention, disorganization, hyperactivity, and impulsivity, is one of the most common neurodevelopmental childhood disorders. Because of the medication shortage, children across the country with the condition fell behind in their schoolwork over the spring, and their relationships often suffered as they struggled to regulate their emotions, according to interviews with multiple doctors and parents. Meanwhile, they all wonder: Why is this happening, and when will it end?
One of the cruelest aspects of the ADHD medication shortage, some parents have said, has been the collateral damage to their children’s self-esteem.
Kari Debbink, who lives in Bowie, Md., said her daughter, who is about to enter her senior year of high school, would lose motivation to do her schoolwork when her ADHD medication, Concerta, was not available in either the brand name or the generic version. Her grades, which had typically been B’s, plummeted — and so did her confidence.
“Once she got behind, she couldn’t catch up,” Debbink said. “By the end of the year, we were just trying to prevent her from failing classes.”
Drew Tolliver, 12, who lives in DeKalb, Ill., typically takes the generic version of Concerta, but since February, his family has had difficulty finding it.
When taking the medication regularly, Drew said, “I felt like I knew myself.”
His mother, Amy Tolliver, recently located the medicine — but she had to pick it up 40 minutes away from the gas company where she works 10-hour shifts, six days a week.
In the spring, Drew would refuse to go to class when he didn’t have his medication, said Michelle Tolliver, Amy’s wife and Drew’s second parent. She and Amy sometimes relented and allowed him to stay home.
“I hated to see him feel like he failed,” Michelle Tolliver said.
Because ADHD medications are considered controlled substances, patients are required to get a new prescription for each 30-day supply.
The use of prescription stimulants to treat ADHD doubled from 2006 to 2016. And between the pandemic years 2020 and 2021, the percentage of people who had a prescription filled for a stimulant rose by more than 10 percent among some adults and teens, according to an analysis from the Centers for Disease Control and Prevention.
The growing numbers — and the ease of being evaluated via telehealth — have raised concerns that some people are being misdiagnosed and that stimulants for ADHD are being overprescribed or abused by people who do not have ADHD but who use the drug to be more productive in school or at work. But this is not the case across the board. Studies have found that girls, people of color and those who identify as LGBTQ are often underdiagnosed and undertreated for ADHD.
Doctors say demand for ADHD medications has also risen because of increasing awareness about the condition in both children and adults.
The disruption in ADHD medications mirrors the shortage of hundreds of other types of drugs, including generic forms of chemotherapy, that have fallen victim to a faltering pharmaceutical supply chain.