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Categories: 2012, February
ADVOCACY IN ACTION
by Ruth Hughes, PhD
BY THE TIME YOU READ THIS ARTICLE, I fervently hope
that none of you are continuing to have difficulties getting your ADHD
medication. CHADD has been working hard to ensure that significant
efforts are made to alleviate the shortage.
CHADD and the American Academy of Child and Adolescent Psychiatry
have joined forces and created a coalition of other patient and clinical
advocacy groups to highlight the seriousness of the problem and to
influence the policies of the two federal agencies with oversight
responsibilities—the DEA and the FDA. We have been talking with
many of the pharmaceutical companies to understand the scope of the
problem. And CHADD has been underscoring the importance of this issue
for the media. More than 4500 people responded to CHADD’s survey
and gave us incredibly important information on the depth and range of
the shortages. For the very latest update, go to the homepage of
chadd.org and click through the ADHD Medication Shortages box.
What caused the shortage?
Each year the Drug Enforcement Agency and the many
pharmaceutical companies manufacturing stimulant medications do a
complicated dance. DEA’s mission is to ensure that only the amount
of stimulant medications necessary for medical treatment is manufactured
and that diversion of these medications for nonmedical purposes is
strongly discouraged. To that end, DEA approves each pharmaceutical
company for a limited amount of the active pharmaceutical ingredient
(API). Once a company has used its entire quota of the API, it either
has to apply for more—a lengthy process—or wait until the
next year to receive a new allotment. Problems at the manufacturing
level, problems with distribution, or an incorrect guess about the
amount legitimately needed, can all result in a shortage. The other
unknown is the growth in the diversion of stimulant medications for use
by college and high school students for studying. Once a shortage
occurs, it is very difficult to address, unless the DEA authorizes more
of the active ingredient. The 2011-12 shortage began with the
short-acting generic versions of amphetamine mixed salts but then spread
to most generic medications for ADHD.
The good news
The DEA has announced new quotas for 2012 with the first
increases since 2007. Amphetamine mixed salts (generic for Adderall)
total allotment has been increased by 36%, and methylphenidate (generic
for Ritalin) has been increased by 11%. This should make a huge
difference in the availability of these medications. But it takes eight
to twelve weeks for the pharmaceutical companies to actually make the
medications and get them to your local pharmacy. It should begin to
become easier to find your medication in late February with an
alleviation of the shortages by the end of March.
CHADD will continue to advocate for policies that prevent such a
shortage from happening again.
The problem of diversion and misuse
Diversion of stimulant medications is one of the culprits in this saga.
The demand among students for stimulant medications to help with
studying has grown substantially. In 2008, Timothy Wilens, MD, and his
colleagues examined twenty-one studies in this area and concluded that
five percent to thirty-five percent of college students report
nonmedical use of stimulant medications in a year. High school student
usage was five percent to nine percent. That has the potential for a
huge impact on the marketplace.
It is imperative that we address the misuse and diversion of these
medications if we are to prevent another shortage from happening in the
future. At an individual level, that means never, ever sharing any
medication with others, and keeping medication in a secure place that
does not allow others to help themselves. At the physician level, that
means screening carefully to ensure that ADHD is present, before
prescribing any stimulant medication. And at the cultural level, it
means encouraging good study habits and strongly discouraging last
minute cramming for exams with the illegal use of stimulants.
Because of the time lag between writing and publication, I encourage you
to visit chadd.org and link to the latest information by clicking
through the ADHD Medication Shortages box on the CHADD homepage.
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