A nationwide shortage of the generic form of Adderall XR, a drug used for attention-deficit hyperactivity disorder (ADHD) in children and adults, has sent many patients scrambling from pharmacy to pharmacy to find it and left others wondering what they'll do if their pharmacies run out.
Shire Pharmaceuticals manufactures the brand name Adderall XR and is under contract to provide the generic form of the drug to Teva Pharmaceuticals and Impax Laboratories, which mass produce the generic. Teva and Impax have accused Shire of not providing an adequate supply of generic Adderall XR. Shire, in turn, says it has provided the amount they agreed to under contract terms. Shire says any shortage is caused by restrictions by the U.S. Drug Enforcement Administration (DEA) on the medications, which are amphetamines, but the DEA denies imposing restrictions that would affect supply.
Regardless of the reasons for the shortage, patients desperately hope they'll be able to get the medication they say helps them get through the day.
"Oh gosh, I don't know how I would function," said Becky, a 52-year-old from Oshkosh, Wis., who's been taking generic Adderall XR. "It helps me get up in the morning and get going. If I didn't have it, I probably wouldn't get up out of bed. I'd be so confused and my mind would be racing."
Nancy Silverman-Konigsberg said the same thing about her 6-year-old son, who started taking mixed amphetamine salts only recently. If he were unable to get his medication, it could have "serious consequences."
"He couldn't sit still during piano lessons and aggravated his instructor regularly," she said. "Since taking the medication, he is able to sit through his music lessons without fidgeting. His [school] teacher reports he can actually sit in one place during rest time instead of roaming the room."
Even with the brand name drug in adequate supply, it's been difficult for many people to get it.
"Patients have had to run around to other pharmacies trying to find the generic, or try to get their insurance companies to cover the brand name product," said Erin Fox, manager of the Drug Information Service at the University of Utah Hospital in Salt Lake City. The Drug Information Service tracks drug shortages nationwide. "Some pharmacies don't even carry the brand name."
Holly Edell's regular pharmacy in Charleston, S.C., ran out of the drug and it's been hard to find it in the area, so she had to try another generic drug.
"I get headaches and neck pain with the alternate and so I've had to adjust my dosage a bit," she said. "However, it's much better than the alternative of not taking it."
Marisa, who lives in Maryland, hasn't had to switch drugs, but it's been difficult to hunt down her medication.
"I have found it increasingly difficult to fill my prescription over the past few months, as the pharmacy is frequently out of the drug and I typically have to check with one or two other locations," she said.
Those who live with ADHD and doctors who treat it know how debilitating the condition can be. Without their medication to keep it under control, the consequences can be serious.
"Adults are more likely to get divorced, underperform at work, have motor vehicle accidents, and if they're not treated, tend to have higher rates of substance abuse," said Dr. Lenard Adler, director of the Adult ADHD Program at NYU Langone Medical Center in New York.
Children, he said, may have academic problems and place a lot of stress on families because of their hyperactivity.
Adler added that if people with ADHD need to switch medications, it can lead to a number of problems. The dosage may not be correct and it will take time to adjust it appropriately, or they may not respond as well to other drugs.
Switching to immediate release forms means patients have to take more than one pill a day.
"Children who need to take medication at school can be stigmatized and adults have to take medications with them," said Adler. "People with ADHD have difficulty remembering things, which will heighten the difficulty of taking it at the time it's needed."
Mixed amphetamine salts aren't the only drugs in short supply. According to the American Society of Health-Care Pharmacists, there are more than 170 drug shortages and most of those drugs are generic injectable drugs.
"There aren't very many companies that make generic injectable drugs," said Fox. "If one company has a problem, it almost always creates a shortage."
For Silverman-Konigsberg, it's something she hopes she never has to confront. Her son's future may depend on it.
"Medication is about giving him the right tools so he can conform to the needs of an education environment," she said. "If he can't attend, he can't learn. If he is running through the class instead of sitting at a desk, he will not succeed."