The U.S. Food and Drug Administration announced a shortage of Adderall six months ago, and Houston doctors and patients are still struggling to find the ADHD medication.
Jenny Kane, STF / Associated PressDr. Cesar A. Soutullo frequently finds himself writing prescriptions for Adderall two, three or even four times before his patients can find ADHD medication in stock at a pharmacy.
It’s been six months since the U.S. Food and Drug Administration first announced a nationwide shortage of amphetamine mixed salts, commonly known by the brand name Adderall. Soutullo, a professor of psychiatry at UTHealth Houston and the director of the ADHD Outpatient Program at McGovern Medical School, said some patients are running out of medication before they can find a refill.
He said he’s spoken to parents with children who’ve had trouble paying attention in school or been overly active without their medication. Some patients may also experience side effects from stopping their medication, such as decreased appetite, trouble sleeping and headaches.
“It generates a lot of practical issues,” Soutullo said.
The FDA announced the Adderall shortage on Oct. 12. It started as a production issue at Teva, which manufacturers Adderall and generic variations of the drug. It was compounded by higher demand, as prescriptions for stimulants used to treat ADHD increased during the COVID-19 pandemic, according to a new report from the U.S. Centers for Disease Control and Prevention.
READ MORE : Adderall shortage leaves people with ADHD in a bind
Certain dosages of the brand name Adderall are no longer in shortage, though manufacturer Teva continues to experience higher demand for the drug, according to the FDA. Generic mixed amphetamine salts are available from some manufacturers, but others are still experiencing supply constraints.
Manufacturers cannot simply ramp up production because Adderall contains amphetamine, a stimulant that is a Schedule II controlled substance. The federal government places strict limits on how stimulants are manufactured, distributed and prescribed because the medications have a documented history of abuse and addiction.
A CDC report found that the percentage of people enrolled in a private insurance plan who filled a prescription for a stimulant rose from 3.6 percent in 2016 to 4.1 percent in 2021. From 2020 to 2021, the number of stimulant prescriptions filled rose by more than 10 percent among females aged 15 to 44 and males aged 25 to 44, the report found.
Soutullo said he was not surprised by the increase, because the CDC estimates that more than 9.4 percent of children aged 3 to 17 in the U.S. have been diagnosed with ADHD.
Alton Bozeman, director of outpatient assessment and an ADHD diagnostic expert at The Menninger Clinic, said one of his children has ADHD and he often needs to try three pharmacies before he can fill a prescription.
READ MORE : What to know about the national Adderall shortage and how it might impact Houston
Bozeman does not prescribe medication, but he said his colleagues and their patients are still being affected by the shortage.
“I’m still hearing lots of complaints,” said Bozeman, also an assistant professor in the Menninger Department of Psychiatry & Behavioral Services at Baylor College of Medicine. “I’m still hearing that refills are taking lots of time to come through.”
Part of the reason for the increased demand, experts said, is expanded access to medication through telehealth. During the pandemic, the DEA suspended a rule that required an in-person examination before providers could prescribe controlled substances. Nearly 40 percent of all prescriptions for stimulants last year came from telehealth visits , compared to less than 2 percent before the pandemic, according to data from the analytics firm Trilliant Health.
However, telehealth prescriptions could change after the U.S. pandemic public health emergency expires on May 11. The Biden Administration has proposed new rules for telehealth prescriptions, including at least one in-person visit to continue receiving Adderall and other controlled substances.
It's unclear how such a change would affect providers and patients, said Tyler J. Varisco, an assistant professor of pharmaceutical health outcomes and policy at the University of Houston. Patients may have trouble getting to an in-person visit due to work or travel constraints, he said.
READ MORE : Persistent medication shortages have Houstonians looking for alternatives
If patients need to find a new provider for an in-person visit, it could also cause problems, Varisco said. Some providers may be wary of trusting a diagnosis that a patient received via telehealth. They might want to conduct a full examination to confirm the diagnosis themselves, which could take additional time, he said.
“I think there is a lack of trust in the quality of care that was delivered to initiate a lot of those prescriptions,” Varisco said.
Bozeman said there’s a “give and take” between keeping expanded access to prescriptions through telehealth or enacting tighter restrictions to limit the potential for abuse and addiction.
“That’s what makes fixing the issue so hard because we do have providers who say we don’t want to go back on this access,” Bozeman said. “But we also have people, including the government, who want to better control internet prescribing.”
evan.macdonald@houstonchronicle.com
