Supply and demand imbalance to blame for attention deficit drug shortage

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Ongoing drug shortages involving medications used to treat attention deficit hyperactivity disorder have been making national headlines, as more parents complain that they are unable to fill their child's prescription for generic medications, including methylphenidate HCI (Ritalin) and amphetamine mixed salts (Adderall).

Due to the medications' potential for abuse, the Drug Enforcement Agency regulates how much of these medications can be produced each year, based on usage data from the previous year.  Some have suggested that drug manufacturers are producing more expensive, newer versions of these medications and fewer generic versions to maximize profitability while staying within DEA-specified drug quotas.

With 18 years experience managing children with ADHD, I can tell you that those who are paying the greatest price are our pediatric patients.  There are various opinions on the best way to diagnose and manage children with ADHD, but if you take the time to make the correct diagnosis, medication can make a miraculous difference in the lives of these children and their families.

Many times ADHD is first identified when untreated children with the condition have difficulty in school. Symptoms also often impact their ability to make friends and get along in social situations. 

I remember one mother and son who sought evaluation for ADHD at a teacher's request, because the child was at risk for failing the third grade.  When I asked the child about his friends, he replied that he didn't really have any, and his mother confirmed this. 

After evaluation, diagnosis and initial treatment, the mother and son returned for follow-up.  The mother was beaming and had tears in her eyes when she stated that her son was now doing his class work and homework and had received an invitation to play at another child's home. 

These are simple developmentally appropriate activities, which many people take for granted. Because there is no physical stigma associated with ADHD, it is easy to forget that these children and their families do suffer when ADHD is left untreated. 

I am not advocating that drugs are the only therapy for patients with ADHD.  Behavioral therapies can also be effective, and are considered optimal treatment in combination with medications.  However, access to behavioral therapy is limited by cost and geography for many families. Additionally, effective behavioral therapy requires a stable home environment, with a family willing to devote time and energy to the endeavor. This is more than some families can accomplish.

Families without access to alternative treatments should not be put in the position of having to request more expensive ADHD drug therapies because it is all that is available.  Some ADHD drugs can cost hundreds of dollars a month, and not all patients respond to the various available stimulants equally. Because of these differences, switching medications from one that effective to another that is more readily available can be risky.

I am not denying that ADHD drugs can be abused, particularly among college students and adults. But clinicians with the ability to prescribe these medications must do their part by providing patients with accurate ADHD diagnoses and optimal management. This includes periodic medication re-evaluation and thorough initial evaluation of new patients, so we are not just refilling prescriptions that someone else started. 

To help health-care providers do this, the American Academy of Pediatrics published revised ADHD treatment and management guidelines in 2011. A revised 2nd edition clinician toolkit is also available in the AAP bookstore in English and Spanish.

Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.


References

American Academy of Pediatrics. “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics. 2011;128:1007-1022.

FDA website. Current Drug Shortages.

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