Heading into the back-to-school season, there has been growing concern among parents of children with attention-deficit/hyperactivity disorder (ADHD) due to the ongoing shortage of ADHD medications. The Food and Drug Administration (FDA) first reported the medication shortage in October 2022. Recent data from SingleCare, an online prescription savings service, revealed a 33% increase in ADHD medication fills for children aged 6 to 17 in August and September 2022 compared to June and July 2022, ahead of the school season. Unfortunately, with the current shortage, many of these children may not have access to their medication for the start of the 2023-2024 school year.
The shortage of ADHD medications is not solely caused by manufacturing disruptions; unprecedented demand also plays a significant role. Dr. Jennifer Bourgeois, a pharmacy and health expert at SingleCare, explains that the restriction on the production of Adderall, a Schedule II drug, by the FDA and DEA, contributes to the scarcity. The active ingredients in stimulant medications used to treat ADHD are strictly controlled by the DEA. This regulatory process may delay pharmaceutical companies’ efforts to scale up production and meet the increased demand.
The shortage predominantly affects Adderall, along with variations of methylphenidate (sold as Ritalin or Concerta). Adderall, being one of the most commonly prescribed ADHD medications in the United States, is experiencing a widespread impact due to the shortage. While some pharmaceutical and manufacturing companies predict that the shortage will subside between August and December 2023, the exact timeline for wide availability remains unclear.
The shortage of ADHD medications not only affects patients but also has repercussions for families and practitioners. Parents are now navigating long distances and calling multiple pharmacies in their quest to obtain these medications. Practitioners are facing the challenge of reissuing prescriptions to alternative pharmacies or switching to different medications within the same or different class. In the worst-case scenario, children with ADHD may have to go without their medication, leading to exacerbated symptoms and difficulties for parents and teachers in managing their condition. Besides potentially impacting students’ academic performance, this situation can raise concerns among classmates of these children.
To mitigate the effects of the shortage, parents need to plan ahead when filling ADHD medications. Typically, there is an increased demand in August since it coincides with the return to school. Dropping off prescriptions at least two days before the medication is needed can help overcome potential delays in medication availability. Consulting with healthcare providers regarding possible substitutions in case the medication is unavailable is another recommended step.
Parents may be tempted to administer lower doses of ADHD medications to make them last longer. However, Dr. Bourgeois advises against this approach, as it can have negative implications for the patient. Instead, parents should collaborate with pharmacists and practitioners to find solutions tailored to each child’s needs. This may involve trying different medications or adjusting the dosage.
When medication is inaccessible, non-drug alternatives can also assist in managing ADHD. Dr. Willough Jenkins, the inpatient director of psychiatry at Rady Children’s Hospital in San Diego, emphasizes the effectiveness of combining treatment methods. Cognitive behavioral therapy (CBT) provides children with strategies to manage the challenges associated with ADHD, such as emotion regulation, social anxiety, and self-esteem issues. Parent training and education are crucial for supporting children with ADHD, as many of them experience behavioral issues. Programs like the positive parenting program (triple P) equip parents with strategies to manage conflicts with their child.
Schools can play a role in supporting children with ADHD through accommodations in the classroom and individualized education programs (IEPs). Additionally, adopting healthy daily habits, including at least 30 minutes of regular physical exercise and ensuring ample sleep (10 to 12 hours for children), is vital. Maintaining consistent sleeping patterns, practicing good sleep hygiene, and minimizing screen time at night can help address sleep-related issues. Mindfulness and meditation techniques, taught by therapists, can assist children in managing difficult emotions. Although there is no specific evidence-based diet for ADHD management, a balanced diet that incorporates protein, fruits, and vegetables is recommended.
In cases where non-drug treatments are not easily accessible, online tools can provide effective alternatives. To address the shortage, the FDA is actively seeking alternative treatment options, including a game-based digital therapeutic designed to improve attention function in children with ADHD. The FDA is also collaborating with drug manufacturers to ensure production matches the DEA’s permitted amount and is urging stakeholders to prioritize patients’ access to appropriately prescribed medications.
In conclusion, the ongoing shortage of ADHD medications poses significant concerns for parents, children, and practitioners, particularly during the back-to-school season. While efforts are being made to address the shortage, caregivers and healthcare providers need to explore alternative solutions and non-drug treatments to manage ADHD effectively. With careful planning and collaboration, it is possible to overcome the challenges posed by this medication scarcity.
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