Ali McGrath, a single mom of two, was recently diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD). For many adults like McGrath, the road to diagnosis is usually long and winding. Often people have lived with the symptoms for years without ever knowing the cause.
McGrath said that it wasn't until she was in college she became aware she had attention issues. "My professors pointed it out to me as they watched me study," she said, admitting she was always doodling in her notebook or her mind wandering elsewhere.
McGrath went to see doctor who confirmed that she hit all the marks for someone with an attention deficit. Her psychiatrist recommended she start on medication, but as it turns out getting a hold of the medication has been the hard part.
After her diagnosis, McGrath headed off to her pharmacy prescription for Adderall XR in hand. She tried four Rite-Aids and a pharmacy near her home in Tinton Falls. "Nobody has it," she said about the dose she needed.
Based on additional symptoms McGrath reported to her doctor, he switched her prescription to Strattera. The pharmacy was out of that one too.
Despite the frustration, McGrath said she is not giving up. "I need to start something because it's affecting so many other things," she said. McGrath noted her ADHD affects everything from her home organization, to her parenting and her general stress level.
Local Implications of Federal Issue
McGrath's experience may be an indicator of a national issue reported recently in The New York Times. According to the Times, the shortage is a result of a conflict between the Food and Drug Administration, which monitors drug safety, and the Drug Enforcement Administration, which sets quotas for the sales of the ADHD medications to keep them from being abused. According to that report, demand for some medications has overrun the supplies that drug manufacturers are allowed to produce. The FDA's list of drugs in shortage includes Amphetamine Mixed Salts, the generic form of Adderall.
Medications used to treat ADHD, such as Ritalin, Adderall, Concerta, Vyvanse and others, are controlled substances, a label the government gives to drugs with accepted medical uses that have a high potential for abuse.
Unlike a script for Zoloft or Lipitor, where a patient can get a prescription with a certain amount of refills, patients who need ADHD medications have to physically visit their doctor once a month to pick up a prescription and then hand deliver it to the pharmacy.
Added to that headache is that ADHD often runs in families, with both parents and children needing medications from different doctors and at different doses.
Shortage Hard on Families
Eva O'Malley, of Howell, is the mother of three. She and two of her children have ADHD and take three different prescriptions. One of her children takes Ritalin, another Focalin, and she takes the generic of Adderall.
O'Malley is also the founder and coordinator of the local chapter of CHADD, a national support group called Children and Adults with Attention Deficit/Hyperactivity Disorder. Her group holds meetings to support and educate parents of kids with the disorder.
She said she began to experience the shortfall of Adderall about six months ago.
O'Malley uses CVS Caremark, which enables her to get her medication through the mail. But when Caremark ran out of the generic it switched her to the name brand, more than tripling her cost. Not ideal, she said, but doable.
Her other choice would have been to go back to the doctor to get a new script for a monthly supply she could fill at a retail pharmacy, that is if she can find one that has it in stock.
According to a forum on ADDitude, a Web site dedicated to people living with attention defecit, the shortage was being reported around the nation as early as March of last year. Participants claimed difficulty in getting their prescriptions of Adderall in different doses and varieties. Some reported that they were forced to switch new medications, with varying degrees of success.
People without ADHD maybe left wondering what the big deal is? Doesn't this just mean that there will be a few more fidgety kids in class?
Not exactly, O'Malley said. Kids and adults can have a range of symptoms from lack of focus to emotional outbursts to dangerous impulsivity. The disorder can also cause friction in relationships and trouble at work. And usually attention deficit is accompanied by other issues like anxiety, depression and oppositional defiance, which can become intense when the stability that the medication provides is taken away.
"With ADHD," she said, "seven-eighths of the iceberg is hidden."
Are Drugs Really in Short Supply? Hard to Tell
When Patch looked into the issue today the anecdotal evidence seemed to be conflicting, with some drugs and dosages available here, but not there.
We asked about Adderall XR 25mg and its generic specifically.
The places we called in Ocean County varied from locally owned drugstores, to supermarket's in-house pharmacies, to drug store chains. Some locations had neither, some had the generic, some had both.
For example, staff at near the Brick-Toms River border told us over the phone Friday that both were in stock.
However, Friday had just the generic, and not the brand name, of Adderall XR 25mg.
Food Circus Foodtown on Route 37 had neither the generic nor the brand name in stock.
We also contacted CVS's corporate office. Michael DeAngelis, director of public relations, said in an email, "Adderall is in extremely short supply throughout the country and has been listed by the FDA on its drug shortage list. At varying times, both brand and generic versions of the drug have been in short supply. And the same applies to extended release and immediate release versions. The shortage is industry-wide and nationwide, although different markets can experience shortages at different times."
What Happens if Your Medication Is Out of Stock?
DeAngelis said, "In the event that a prescription medication is not available because of a manufacturer’s shortage, our pharmacists will work with the patient’s physician to try to take care of their needs, including the possibility of moving the patient to a different prescription if appropriate. The solution will vary based on the specific circumstances of the patient and the medications involved."
In the meantime, people like McGrath and O'Malley will be left scouring the county for the medications they need.
"If there was a shortage of insulin," O'Malley said, "People would be screaming their heads off."