The Shortage Of Adderall . . . and the scramble for solutions

As most of you ADHD kids/moms/dads know by now, there is a shortage of Adderall products in the United States.  It has simmered all summer . . . only to hit the big time now that school is in full swing (great timing, big pharma!!).  It has created havoc across the area and quadrupled the calls to the already full in-box on my voice mail.  Everybody is blaming everyone else . . . I have yet to hear anyone accept responsibility for this shortage.  Do you think a shortage of statins or a shortage of blood pressure medicine would be permitted or tolerated?  I would expect a congressional inquiry!!!  I expect no such investigation into this shortage.

From a practical standpoint, however, we on the front lines of mental health treatment have to deal with this in a productive way.  So what are our options . . .

1.  As faithful blog readers may remember, Adderall is a dexedrine based product.  Switching to another dexedrine based product is a reasonable step.  Your two options are:  a) the long acting brand-only Vyvanse, or b) the short acting immediate release dexedrine.  Why these two products (similar in composition to Adderall) are still available is beyond me, but so far I have heard of no shortages.  I have written about Vyvanse before, so you know it is a medicine that I favor.  But , being brand-only, it can be more expensive on your co-pay, and is certainly much more expensive than generic Adderall for the insurance company to pay for.  Short acting dexedrine is more typically used as a “booster” in the afternoon for when kids or adults are coming down off their Adderall-XR.  It can extend the benefits for focus and concentration and still be out by bedtime for sleep.  Dexedrine taken in the morning, however, will be out by noon, and will require a booster of more dexedrine at lunch time in school . . . and then again in the afternoon . . . kind of like 1993 before the advent of long acting stimulant agents.  Remember the long lines at the school nurse’s office at lunchtime . . . ???  I wonder if we are heading back in that direction for a while!!!

Since all these products are based on the same raw materials, I wonder how long it will be before there is a shortage of these products as well.  Thats why it may make more sense to consider . . .

2)  Switch to a Ritalin based product.  Methylphenidate (aka Ritalin), is “the other stimulant”.  So far, I have not heard of shortages of any Ritalin-based product from patients in my practice, but there are rumblings out there in the press.  Since most kids will do well with any stimulant product, it is typically not a big deal to switch.  It does require that adjustment period where the correct dose is determined.  That can be a process that takes weeks or months to determine, although there are ways to shorten it (see below).  Products based on methylphenidate include Concerta, Metadate, Ritalin-LA, Daytrana patch, and Focalin.  Some are generic . . . some brand only.  While there is no absolute conversion between a dexedrine based product and a methylphenidate based product, it is understood that dexedrine is more potent and you need numerically more mg’s of methylphenidate to get the same benefit as you get with a dexedrine based product.  The long-release products make the titration a bit more tricky, but nothing beyond abilities of the average shrink.

3)  Strattera.  Rarely my first or second choice . . . hence it comes in as #3 here.  Strattera is great when it works . . . but just does not work as often as the stimulants.  The typical trial of Strattera can take 4-6 weeks . . . valuable weeks at this stage of the academic year.  For some, though, it may be the best next step. Especially if previous trials of stimulants have not been well tolerated.

4)  Homeopathic or natural remedies.  Ok, this is where I go out on a limb . . . but not too far.  I have seen reports and have spoken to one . . . (1) . . . parent who’s child got much better on a homeopathic remedy.  I am sure there is much more information out there than I am aware of.  Like most psychiatrists out there, I have been, a student of standard western medicine.  But I have been as frustrated as many of you at the side effects and difficulties associated with many of the standard medicines for ADHD.  That, and the recent shortage of Adderall, has me investigating some options.  I will give no opinions at present because I don’t know enough . . . but stay tuned!!!

The other point I will throw out there is the availability of the Quotient ADHD testing system to accurately test for the core symptoms of ADHD.  I have spoken about this before, and there is plenty of info on my website about it, so if you are unfamiliar . . . go take a look.  What the Quotient has to offer is a rapid assessment of the benefits of an intervention for ADHD.  Whether someone is switching to another stimulant, to Strattera, or to a natural remedy, use of the Quotient allows for objective documentation of the intervention’s benefits quickly and accurately.  This can help prevent the real danger inherent in medication switches–months of academic down-time while the new intervention is tried.  Like I’ve said before . . . childhood is short.  You don’t want a child under-treated for their ADHD because of the potential risk of academic difficulties, self-esteem loss and anxiety.