National Shortages of Stimulant Medications

Nation wide shortages of primarily amphetamine formulations of stimulant medications has been an issue since July 2022. There are multiple factors contributing to shortages. In 2021 due to the opioid crisis a pharmaceutical manufacturer and three pharmaceutical distributors agreed to a $26 billion dollar settlement earmarked for health care and drug treatment programs. Meanwhile pharmacy chains such as CVS and Walmart have agreed to pay more than 10$ billion for their role in the distribution of opioids.

Although no one is taking responsibility for their part in the crisis, there is now greater oversight and monitoring by companies, pharmacies, pharmacists and physicians. Opioids are considered Schedule II drugs by the Drug Enforcement Agency (DEA). Schedule I drugs have no accepted medical use and high abuse potential such as LSD, heroin, marijuana and ecstasy. Schedule II drugs are deemed to have some accepted medical use but a high potential for abuse, and may lead to severe psychological or physical dependence. Examples include the opioids, fentanyl and cocaine. Although widely accepted as the mainstay of treatment for ADHD in children, teens and adults Adderall and Ritalin are still classified as Schedule II drugs. With the increased oversight and monitoring of opioids, ADHD medications are being included given its classification. Pharmacies, pharmacists and physicians are much more vigilant in prescribing and distributing these medications.

Contributing to shortages is the increase in prescriptions due to the increased number of patients who are being evaluated, diagnosed and treated through Telehealth including companies such as Cerebral. There has been an emergence of such companies since the beginning of the COVID pandemic. In addition manufacturers of medications were faced with a shortage of employees especially during the lockdown period during the initial phase of the pandemic. 

Shortages seem to have affected amphetamine formulations more than dexmethylphenidate/methylphenidate medications, however, there has also been an increase in shortages in this group of stimulants given that patients on amphetamine formulations are being switched over to dexmethylphenidate/methylphenidate (Focalin/Ritalin). 

The opioid crisis gives us an opportunity to reevaluate the DEA’s classification of stimulants prescribed to manage the symptoms of the most common neuro-developmental disorder, ADHD, which as we now know consists of symptoms that last throughout one’s lifetime. Research confirms the negative impact untreated ADHD has on for example longevity, financial status and relationships.

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