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Shortage of ADHD drugs causes ‘scavenger hunt’ for Iowa families
Reason for shortage includes increased demand, production delays and DEA limits
For Jill Delowery, getting medicine for her daughters’ attention deficit hyperactivity disorder was like a “scavenger hunt” — but not a fun one.
“You had to call around to every pharmacy to see if they have it,” said Delowery of Iowa City. “Then it’s a timing thing because your doctor has to call in the prescription. By the time they call, the pharmacy might be out.”
And this process repeats itself every 30 days because the federal government — leery of stimulant abuse — requires health care providers to reauthorize ADHD prescriptions every month.
There’s been a national shortage of ADHD medications for more than a year. What started with manufacturing delays for a producer of Adderall in October 2022 has turned into erratic availability of methylphenidate, sold under brand named Ritalin and Concerta.
The shortage is caused by multiple factors, including production problems for manufacturers and limits the U.S. Drug Enforcement Agency puts on how much controlled substances a company can produce, said Mike Brownlee, chief pharmacy officer for the University of Iowa Hospitals & Clinics.
To make it easier for health care providers to treat patients during the COVID-19 pandemic, the federal government allowed online providers to prescribe stimulants without an in-person visit.
“Demand has increased substantially since prescribing rules for ADHD medications were loosened during the pandemic,” Brownlee said. “It has exacerbated the (shortage) problem, but it’s unclear by what percentage.”
When families can’t get medicine, they might ration their supply or cut doses in half to get by, he said.
“For kids, it can lead to challenges at school due to inattention and relationship problems,” Brownlee said. “For adults, it can lead to lack of focus at work or in normal daily life functions like driving. While holding doses may not be life-threatening, it can lead to significant personal and societal challenges.”
Dr. Robin Kopelman, a psychiatrist who works with adult female patients through Meadowlark Psychiatric Services in North Liberty, said the monthly hunt for medications is an additional hardship for adults with ADHD.
“Depending on how significant somebody’s symptoms are, calling around to pharmacies when you are out of medicine, that’s a real challenge on the patient end,” she said.
What is ADHD?
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder usually diagnosed in childhood, but that can continue for many adults. People with ADHD may experience, to a greater or lesser degree, an ongoing pattern of:
- Inattention — having difficulty paying attention
- Hyperactivity — having too much energy or moving and talking too much
- Impulsivity — acting without thinking or having trouble with self control
The disorder is thought to be caused by a combination of genetics, brain makeup and environmental factors. There’s been an increase in the number of children diagnosed with ADHD since the late 1990s, but scientists don’t know if that’s because more kids have the disorder or it’s just being diagnosed more often, the U.S. Centers for Disease Control and Prevention reported.
Health care providers like Kopelman have gotten creative to help patients get needed medications. This might involve prescribing a slightly smaller or larger dose, switching brands or using a different form of the medicine, such as slow release, she said. The FDA in August approved a generic form of ADHD drug Vyvanse, which has created some additional options.
There also are some non-stimulant options, such as Wellbutrin or Strattera, that could be used by some ADHD patients, Kopelman said.
“We try to problem solve as much as we can,” she said. “It's been a real circus.”
Insurance companies have added some extra hurdles. Delowery’s first insurance carrier would only cover name-brand methylphenidate. But when her family switched insurance companies in 2022, the new company would only pay for generic unless no pharmacies in town had it. The name brand can cost 10 times more than the generic.
When the 72 milligram dose was unavailable, the Delowerys’ doctor prescribed prescriptions for 54 milligrams and 18 milligrams to get their daughter to the right dose. But the insurance company did not want to pay for two prescriptions, she said.
“The doctors are trying to do things to get you the medicine you need, yet the insurance company is still saying no,” she said.
Delowery had since signed both of her daughters up to get mail-order prescriptions through the insurance company. This way, they get a 90-day supply without having to get reauthorization. The downside is it takes two weeks to get the medicine, so the family has to plan ahead.
Kopelman said she looks at the shortage of ADHD medication through a public health lens. If there’s not enough to go around, she encourages families to think about whether they can get by without the medication on weekends or school days without tests. Unlike some drugs that shouldn’t be stopped suddenly because of dangerous withdrawal symptoms, if ADHD medications aren’t taken one day, they just don’t provide the positive benefits that day.
“That’s not an option for everyone,” Kopelman said of taking days off. “We’re making sure we’re prescribing stimulants for the people who are most in need.”
Comments: (319) 339-3157; erin.jordan@thegazette.com
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