This past week, mainstream media has been telling the story of a shortage of drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD). The drug getting the most attention is Adderall.
Drug Enforcement Administration and Drug Manufacturers Face Off
The Drug Enforcement Administration (DEA) sets manufacturing quotas for controlled substances. The active pharmaceutical ingredient (API) in Adderall is mixed amphetamine salts, which is a schedule 11 controlled drug. What this means is that Adderall can be extremely addictive. The job of the DEA is to protect the public from abuse, but also to ensure there is enough of the API available to manufacturers so that they can produce enough medication to make certain all legitimate prescriptions can be filled.
Drug manufactures claim they aren't getting enough of the API to keep up with demand. The DEA claims that the pharmaceutical companies make plenty of their high priced variety, but cheat on the less expensive generic brands. Also, the DEA claims that the manufacturers can receive more than their original allotment by asking for additional API. Drug companies claim that it takes two to three months for a request to be processed, and twelve weeks to manufacture new medication. Therefore, shortages arise.
The slant of recent news stories has been how there is a lot of finger pointing going on between the DEA and drug manufacturers, while the patients suffer, searching high and low to find a pharmacy that can fill their prescription.
Is Attention Deficit Disorder Over Diagnosed?
There's a back-story that needs attention.
Until the mid 20th Century, there wasn't a name for what ailed children who suffered the symptoms of ADHD. They were simply children who didn't know how to behave. They couldn't sit still, pay attention or maybe subjected others to their temper tantrums. They were either punished for bad behavior, or left to run wild.
By the mid-20th Century some of the children displaying these symptoms were given the label, minimal brain dysfunction. And, by the mid-1960's Ritalin was introduced to treat children with minimal brain dysfunction, which eventually evolved into the nomenclature ADHD.
By 2003, five to six million American children were diagnosed as having ADHD. However, there are no biological markers, no single test or assessment approach, and no evidence of the long-term effectiveness of psychotropic treatment in modifying behavior.
Because there is no definitive test to diagnose, ADHD biases appear to exist. Non-minority boys under the age of ten are more likely to be labeled with ADHD. Children who are the youngest in the classroom, (Rush University), those whose birth dates fall at the end of the cutoff, are more likely to be reported by teachers as having symptoms of ADHD. It's been reported that approximately one million children are misdiagnosed annually. (Rush University)
Are Psychotropic Drugs the Best Solution?
Perhaps, behavior modification treatment is at least as effective as drug intervention. But, behavior modification takes time and a great deal of effort. Swallowing a pill is easy.
Whether or not given psychostimulants, as noted in a 2003 study titled, "ADHD among American Schoolchildren," published in the Scientific Review of Mental Health Prectice, ADHD children are still three to seven times more likely to have problems at school. They are more likely to be expelled, suspended or to repeat a grade.
That being said, sales of ADHD medications have risen rapidly. (NYT) From 2009 to 2010 prescriptions of Adderall were up 13.4% (Reuters) The Adderall shortages have caused patients to seek out Ritalin, which is a similar, but older medication. Thus, there is an increasing shortage of Ritalin.
The stimulants used to treat ADHD are coveted street drugs. Some students, in particular, like to take Ritalin or Adderall that is not prescribed for them because these drugs are stimulants. Stimulants create a sense of greater alertness and make possible sleepless nights of intense study. But, drugs like Adderall are seriously addictive. The question isn't, do ADHD students that legally use stimulants sell their medication, but how often.
The DEA calculates how much API drug manufacturers need in order to produce sufficient quantities of the medications to ensure patients get their prescriptions filled. But, the number of prescriptions is on a steep incline. Therefore, quotas of API need to be, and apparently are, increased.
Although the battle appears to be primarily between drug manufacturers and the DEA, it behooves end users to research, contemplate and clarify whether or not medication is their best alternative. It might not be.
Sources
New York Times - FDA Finds Short Supply of Attention Deficit Drugs
Reuters - Shortage of Adderall Still Persisting
NPR - Shortage of ADHD Drugs has parents and Doctors Scrambling
Commission for Scientific Medicine and Mental Health - ADHD among American Schoolchildren
Disclaimer
The information contained in this article is for educational purposes only and should not be used for diagnosis, or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or, her health should contact a doctor for advice.
Oreen Scott - After twenty-two years in the newspaper business, three years ago Oreen sold her house, car and almost everything she owned. A Canadian by ...
