Apr 3, 2024 - Health

More Americans forgoing ADHD meds as shortages drag on

Prescription fill rate for common ADHD treatments
Adapted from Truveta; Chart: Axios Visuals

Shortages of commonly prescribed drugs for attention deficit hyperactivity disorder have stretched on for nearly 18 months, with no clear end in sight for many Americans who've found it difficult if not impossible to get the treatments.

Why it matters: As demand for stimulants like Adderall and Vyvanse soared, the fill rate for such prescriptions has dropped more than 10% in two years, according to a new analysis from health analytics firm Truveta.

  • The drop is "quite striking," said Truveta vice president of research Nick Stucky, whose team analyzed de-identified records of more than 336,000 ADHD patients.

The big picture: ADHD drugs are among a high number of generic medicine shortages in recent years that include cancer drugs, asthma medication, hormones and children's Tylenol.

  • Among the problems in many cases is a broken market for older, cheaper drugs that defies an easy fix.
  • The problem has recently been getting attention on Capitol Hill and from federal regulators.
  • The Department of Health and Human Services in a white paper Tuesday said statutory changes and more funding are needed for "more impactful and enduring solutions" than the ones it's already taken to address shortages.

Driving the news: Patients struggling to find ADHD drugs have aired their frustrations in thousands of comments filed to the Federal Trade Commission, which is studying possible factors driving shortages.

  • "I have not been able to fill my prescription at any pharmacy I've been to including Costco, CVS, Publix, Walmart, and local discount pharmacies," wrote a man who identified himself as a medical student in the Miami area.
  • One woman said she's had trouble each month filling a prescription for her son, a sixth grader. "Recently his teacher asked him to find a way to 'just stay home' until his medication becomes available again," she wrote. "Can you imagine what it feels like for a child to hear this?"

Between the lines: Likely drivers of the shortages include pandemic-driven increases in demand, caps on production of the drugs, and the threat of rolling back rules making it easier to prescribe stimulants virtually.

  • The Drug Enforcement Administration and Food and Drug Administration last summer also said manufacturers were not producing the full amount they were allowed. The DEA did not respond to a request for comment.
  • "The question is, 'What is now perpetuating the shortage?' And that's not a question that's been adequately answered," Johns Hopkins psychiatry professor David Goodman told CNN.

Zoom in: Gene Rhea, a pharmacy official at Duke Health, said patients most affected by the shortages are those who need a specific strength or dosage and can switch, but might have a treatment delay or be stuck with higher out-of-pocket costs.

  • New York psychiatrist Judith Joseph said sometimes her office has to call 20 pharmacies just to locate a stimulant for one patient.
  • The inability to maintain their prescription can hurt ADHD patients' ability to focus and problem-solve, and it can put a strain on relationships, Joseph said.
  • "For someone accustomed to receiving those supports, it's really frustrating," Joseph said. "People are just getting fed up."
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