36
votes
A US drugmaker’s feud with the DEA is exacerbating the ADHD meds crisis
Link information
This data is scraped automatically and may be incorrect.
- Title
- The Empty Adderall Factory
- Authors
- James D. Walsh
- Published
- Feb 19 2024
- Word count
- 2737 words
Thanks for posting this. It was a good read.
I was thrust into the world of ADHD medication when I got my diagnosis in July last year. Everything in this article, and everything about the shortage is so hard to read. I am so thankful that a non-stimulant has been successful for me. I can get 90 day prescriptions with refills for a year without an issue.
From everything I have seem, it seems like, despite their claims to the contrary, the DEA is trying to limit the supply as much as possible. Not allowing a manufacturer to make drugs because some employee forgot to write "cancelled" after they crossed out an order is bullshit. Yes, those types of issues should be addressed, but the DEA should be doing everything in it's power to get the manufacturer into compliance, not shut them down.
I think ADHD has been underdiagnosed for decades, but to give the benefit of the doubt, lets assume that there is an epidemic of false diagnoses right now. How should we address this? We should address it with regulations on the prescription of drugs, not the filling of that prescription. Once someone has a valid prescription, it should be simple to get the drug. Remember, this is being used to treat a disorder that reduces executive function. If we require people to jump through hoops, or drive hours, or visit 20 different pharmacies just to find their medication, it will do significant harm to those people. Even if this disorder didn't cause executive function issues, I think those requirements are insane. Imagine if we required cancer patients to take road trips to every pharmacy in the county just to find chemotherapy drugs? The fact is that some medical professional thinks these people need this medication. So why is our government trying to prevent that person from getting the medication? Does the DEA know psychiatry better than the literal trained psychiatrists?
This is bullshit. The DEA needs to get back in their lane and stop meddling. Their goal needs to be to allow manufacturers to comply with laws while producing medication, not to reduce the supply of medication.
There are a huge number of ways this can be addressed, or levers which would ultimately affect how many people get a particular diagnosis. But I think it places emphasis on the wrong part of the equation. If a diagnosis did not have a medication treatment, would it matter how many people had a "false" diagnosis? I personally think it does, but for reasons outside the scope of this comment (happy to discuss if anyone wishes).
People are calling it a false diagnosis because they are working backwards from the framing point of the opioid crisis. But the opioid crisis wasn't caused by too many people having a 'false' diagnosis. The concern is about what can happen with some people who are prescribed a drug. We should be framing this as a potential lever for drug addiction. When we start from the correct framing point, we have much clearer courses of action.
There's plenty of literature to support that the ways out of a drug addiction are multitudinous and what works for one individual may not work for another, but there are also clear levers which help and ones which do not. Controlling legal access to a drug does not reduce rates of addiction, and in fact has been shown in many cases to increase addiction at a population level because people turn to the alternatives that they can get their hands on. People will absolutely self-medicate to solve problems and making a drug illegal or difficult to acquire simply encourages capitalism to solve the problem with alternatives (be they through legal or illegal means).
Increasing access to drug recovery programs and addiction specialists decreases rates of addiction. This is probably the most costly of countermeasures, but unsurprisingly professionals who deal with addiction do a good job at reducing addiction. Increasing awareness about the potential for abuse and training doctors who prescribe to adequately counsel patients is also proven to be effective. The efficacy of this is less, but we figured this out during the opioid crisis, and it's relatively cheap to do. Of particular note, continuing medical education which emphasizes the need for providers to monitor their patients for signs of addiction and collecting information such as social history are great methods at proactively identifying patients who may be struggling with responsibly managing their medication.
I think this part is absolutely key - drug monitoring done in the clinical context with the input of both the provider and the patient is perhaps the most important key to managing medical substances with potential for addiction because most patients do not want to be addicted and if you catch them early enough are not only active, but are engaged at preventing or reversing the course of addiction. Unfortunately, for whatever reason, this has not been the accepted or adopted approach by the US government when it comes to controlled substances. The only lever they've repeatedly pulled is the "deny/restrict access" lever and it's one of the reasons we've had an opioid crisis for so long.
I have high blood pressure so I can't take stimulants. If you don't mind me asking, which non-stimulant have you found success with?
I am using Straterra (generic). It also has hypertension as a possible side effect, so I don’t know if it will work for you, but it’s worth asking. I actually did have some high blood pressure issues in the first few months on straterra. I addressed it with daily exercise, most often running. Exercise is even a very good treatment of ADHD directly, not to mention the other benefits. But I know first hand how difficult it can be to find the motivation.
When I was dealing with my blood pressure issues, my psychiatrist mentioned another drug, clonodine. It’s normally a drug for high blood pressure, but it is also used off label for ADHD. I haven’t used it myself, but it might be worth asking your doctor about it.
Gave me some trippy dreams and some nausea iirc (been about 20 years since I was on it). I swore off it pretty quickly. But meds hit everyone different. And boy do I wish for the ease of a non-controlled substance.
I take Guanfacine (generic for Intuniv). It's used off label for ADHD, and on-label for heart medication.
I'm here with you. It's not a cure-all, but it has definitely helped give me a proper 'nudge.'
It also lowers your blood pressure, a nice double-whammy.
Most definitely! Especially since Adderall will more than likely raise it!
I actually just started Guandacine recently! I'm only on 1mg now. I'm starting super low since a lot of meds have increased my BP or increased my depression/anxiety. So far so good, but it's only 1mg so I wasn't expecting much. Fingers crossed this is the one. But I've said that before.
Fingers crossed it works out for you! I'm on 3mg now. I was on 4, but that gave me horrible heartburn so we had to dial it back a bit. 3mg seems to work ok, 4 worked better for the ADHD, but the heartburn wasn't worth it lol!
It's supposed to decrease BP/HR so be really careful about standing up quickly!
iirc the two non-stimulants others mentioned are the only ones with a solid track record medically. I've also heard of some doctors using welbutrin off-label for ADHD (though I responded poorly to it personally).
I took Wellbutrin for about 2 years and never felt my ADHD symptoms lessen. I had no idea it's used off-label for ADHD until now! TIL!
I'm not sure how well-validated its efficacy is but it's definitely a thing I've heard mentioned in my ADHD books. I personally responded really poorly to it side-effects-wise when I tried it so I can't attest to its effects on my ADHD symptoms either.
I tried Wellbutrin in high school. It made me very flat. I wasn't happy or sad, I was just existing. I was constantly asked if something was wrong. I'm curious if it would be different as an adult.
I had the opposite response to it actually! It made me very jumpy and unfocused, something akin to a hypomanic episode. My mother is on it for her anxiety and iirc tolerated it fine though. Meds like this vary so much person to person!
I have some friends that Welbutrin works well for, but I had a similar experience to what you mentioned. I also felt flat.
When on it, I had zero contrast so everything felt bland and my emotions were heavily muted.
As a woman who was misdiagnosed for anxiety/depression instead of ADHD (undiagnosed my whole life before the misdiagnosis), I'm so tired of the "rapid rise in prescriptions for stimulant medications" talk. It's not an out-of-the-blue thing. Women are finally getting properly diagnosed with ADHD when/if they have it, and it's making things better when we can get our meds. The days I don't take my adderall (but just take my guanfacine, a non-stimulant medication), I notice a difference in how my brain works and how I function - which is to say, I barely function, and have no idea how I ever functioned without. I really struggled with everytying and nothing came easily or naturally to me without the adderall.
It's also really funny to me: My insurance changed at the begining of the month and all of my scheduled drugs (cymbalta for fibro, adderall for the adhd, and ativan for dental appointment anxiety) were all totally fine and no issues with them, but the guanfacine, a nonstimulant medication used on-label as a heart medication and off-label as a non-stimulant ADHD medication needed prior authorization as did my cingulair for asthma, but my epi pen and my inhaler for allergies didn't require it.)
EDIT: I want to also add this: "To many observers in the industry, concerns about abuse of ADHD medications are outweighed by the harm done to the people with genuine diagnoses who can’t access the pills they need to function." from the article. This is the exact same argument people with chronic pain have had to have about opioid medications. Just because it has the potential for abuse doesn't mean the people who need it don't need it anymore when you make it harder to get. Those people while also suffer because they can't get their meds, and possibly die, whether naturally or by
TW
taking their lives because they couldn't get the medication. I knew someone who did this. He was a very close family friend and it's still hard to think about him killing himself because he couldn't get medical help he needed for his pain.
The complete disregard for the safety and well-being of people who need these drugs to survive is the part that frustrates me the most. People act like they don't exist when they decide policy on how to stop the problem. How much harm is caused to people who need these medications in order to stop or slow an unintended side effect? Are you causing more overall harm by reducing how many people end up addicted because you're creating a bigger burden for those who have a clinical need? Practically no one bothers to measure these harms against each other and the involvement of patients in these kinds of decisions is basically none or performative at best.
We need to stop placing moral judgements on drugs. It clearly poisons the discussion and shoehorns us into 'solutions' which involve policing. These 'solutions' do not work. We've repeatedly shown they are not effective. We have decades of science showing that addiction is a medical problem, which can be solved with medical interventions. Medical professionals should be in charge of setting and enforcing policy.
I absolutely agree with you. We also need to place more value on addiction help. Addiction is not a moral failing, like you said, it's a medical condition. Anyone can become addicted to something - food, alcohol, drugs, sex, etc. There is no reason to stigmatize this issue when it's something that can be medically helped.
The fact that some people are more prone to addiction doesn't mean that there are not also people who desperately need these medications, even if they, too can become addicted.
I feel 50/50 about this. I have ADHD so I understand the impact to the community buuuut, I think pharma in general has hidden behind the "we can't be held accountable because impacting our throughput would negatively impact patients."
It sounds like more of the issue is opioids that the facility produced and I think wrangling opioids is valid. However it does seem like the levers the DEA is choosing to wield is out of whack. I think we need to think about introducing criminal penalties for gross negligence or malicious marketing, particularly in the field of medicine and infrastructure. I think that would do more than any pointed closures would to limit the amount of drugs being "pushed" by our system.
Getting medication advertising out of the public would be such a help with issues like this.
I also think we need to consider that so many of the patients who have been diagnosed with ADHD since the pandemic began are adults, and mostly female-presenting/AFAB people because ADHD doesn't present the same way in females and males, and until very recently, female ADHD symptoms weren't considered part of the diagnostic criteria. Now that we have this access to sorely needed medication, it's being pulled away again because of the shortage. I personally have rationed my medication at first because I couldn't get it when I needed it, and then when I finally was able to get it consistently, because others are struggling and I know what it's like to live my life with ADHD without meds, ao I was hoping it would help kids who need it too.
Here's a few sources ranging from journal articles to presentations by advocacy groups to research conducted by electronic healthcare companies:
Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women
Looking Back on 42 Years of Research on ADHD in Females
Number of ADHD Patients Rising, Especially Among Women
ADHD: a women's issue
Attention-Deficit/Hyperactivity Disorder Predominantly Inattentive Subtype/Presentation: Research Progress and Translational Studies
I'll have to look and see if I can find any, but it's been from my experience, and the experience of most of the AFAB ADHD people I know/come across in the world (so, anecdotal, but it's pretty overwhelming in my sphere).
Archived Link
I am narcoleptic (N2). The shortage has nearly destroyed my life.
It was nice to see narcolepsy mentioned in this, but it is still such a distressing read.
Vyvanse generics were not approved by the FDA until August of 2023. (1) (2)