ADHD Drug Shortages: Causes, Implications, and Solutions

Image Credit: Adobe Stock Images/Vitalii Vodolazskyi

Over the past few years, a combination of supply chain issues and rising diagnoses of attention-deficit hyperactivity disorder (ADHD) has led to a major shortage of medicines focused on treating individuals with the disorder. During the height of the COVID-19 pandemic in 2020, The American Medical Association labeled the limited inventory as an urgent public health crisis.^1-3

In the United States, studies have found that the biggest contributor to the rising demand for ADHD drugs was young adults, aged 22 to 44 years, with prescriptions for the most commonly used drug rising by approximately 50% in this group between 2018 and 2022. According to a 2020 survey by Forbes, there is currently an estimated 8.7 million adults in the United States living with ADHD, 366 million globally, and approximately 129 million children globally.^1,4

As a result of this issue, doctors in the UK have reportedly been given instructions not to write prescriptions for newly diagnosed patients with ADHD until supply issues have been resolved. Furthermore, National Health Service England is expected to offer advice on identifying patients who would be most at the greatest risk from treatment interruption and whose medicine supplies should be prioritized.¹

In October of last year, the FDA revealed worldwide shortages of Adderall, which resulted in an increased demand for therapeutic alternative medications, such as various methylphenidate (MPH) formulations. As a result, top MPH products, such as Ritalin and Concerta, have started facing supply shortages as well.^2,5,6

There has been major implication for the shortage, especially among children who rely on various ADHD medications to focus during the school day. Additionally, pharmacists have had to jump through hoops trying to figure out appropriate substitutions. Because ADHD medications are controlled substances, prescriptions have to be filled monthly because only one 30-day supply is distributed at a time.⁷

"This is very different than any other medication shortage. We're talking about children. We're talking about their education," said Eric Ball, MD, in an interview with CBS News. "Because of these shortages, we have children who have to jump from one medicine to the other, and every month, every week. They're feeling differently. They're learning differently. This is really, really hard on kids."⁷

The FDA and the DEA recently released a joint statement on the issue. According to the statement, they are "working closely with numerous manufacturers, agencies, and others in the supply chain to understand, prevent, and reduce the impact of these shortages." They claim that the shortages were a result of a manufacturing delay experienced by one drug maker combined with the widespread misuse of the drugs.⁷

In a recent interview with Pharmacy Times, Alfred L’Altrelli, PharmD, CFMC, MBA, senior director of pharmacy at UPMC Presbyterian-Shadyside, offered thoughts on what pharmacists could do to navigate these shortages.⁸

“Collaboration with other healthcare providers is a cornerstone of our approach,” he explained. “Together, we explore alternative strategies for pain management. Pharmacists excel in tasks such as dose conversions, meticulous calculations, and dose adjustments tailored to a patient's specific needs. We consider various treatment options to provide the best possible care. “In the hospital setting, we are well-versed in providing guidance on transitioning between opioids safely. This involves ensuring that when switching from one opioid to another, the conversion is equitable and potent, mitigating the risk of adverse effects. This expertise becomes even more crucial during shortages when alternative selections are necessary.”⁸

References

1. Why is there a shortage of ADHD drugs and what can people do? NewScientist. October 31, 2023. Accessed November 3, 2023. https://www.newscientist.com/article/2400281-why-is-there-a-shortage-of-adhd-drugs-and-what-can-people-do/?_ptid=%7Bkpdx%7DAAAAse82Is3zdQoKcmJhNGYxWmNwZRIQbG9pbHNoNnFjcDVseWtwchoMRVg0T1lJVExZRUU2IiUxODIzamJvMDhrLTAwMDAzMnNsNmIxdW5mOXQwdnR2Y3JwM2JnKhtzaG93VGVtcGxhdGU2MjRIQkkxSUVSUkExMTkwAToMT1RDTzJDNlc2NEhGUhJ2LXYA8Bd0aWoycG9rdjNaDDEwMC4xLjIxNy4yM2IDZG1jaK73mKoGcBh4BA

2. Anticipating Drug Shortages During Supply Chain Disruptions: Implications for Children With ADHD. Pharmacy Times. July 25, 2023. Accessed November 3, 2023. https://www.pharmacytimes.com/view/anticipating-drug-shortages-during-supply-chain-disruptions-implications-for-children-with-adhd

3.AMA says drug shortages an urgent public health crisis. Tribune Star, November 27, 2020. Accessed November 3, 2023. https://www.tribstar.com/news/local_news/ama-says-drug-shortages-an-urgent-public-health-crisis/article_2c130d04-ba01-5dcb-8b8f-3a11089550d6.html

4.ADHD Statistics And Facts In 2023. Forbes Health. August 23, 2023. Accessed November 3, 2023. https://www.forbes.com/health/mind/adhd-statistics/

5.Ritalin Drug Shortage Explained: Low Supplies Of Adderall And Prescription Startups Fueled Crisis. Forbes. January 27, 2023. Accessed November 3, 2023. https://www.forbes.com/sites/conormurray/2023/01/27/ritalin-drug-shortage-explained-low-supplies-of-adderall-and-prescription-startups-fueled-crisis/?sh=337f123a421a

6. ASHP. Methylphenidate Hydrochloride Extended Release Oral Presentations. Current Drug Shortages. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=896&loginreturnUrl=SSOCheckOnly. Published January 10, 2023. Accessed November 3, 2023.

7. ADHD medication shortage continues, causing students to struggle. CBS News. September 28, 2023. Accessed November 3, 2023. https://www.cbsnews.com/losangeles/news/adhd-medication-shortage-continues-causing-students-to-struggle/

8. Opioid Drug Shortages Affect Patients, Health Systems. Pharmacy Times. September 28, 2023. Accessed November 3, 2023. https://www.pharmacytimes.com/view/opioid-drug-shortages-affect-patients-health-systems