Shortage of ADHD drugs

Posted on October 30, 2011 by Linda

We can't get our ADD meds and we're losing focus faster than a defective camera lens. What gives?

First, everyone (OK, doctors) convinced us that we should take meds for our ADD. So we get our prescription filled, our brains come to attention, we get things done and then ... and then ... no medication!!!!

Is it a conspiracy? Is it corporate manipulation? Is it ghosts on Halloween?

Well, it's probably not ghosts but there aren't clear reasons for the shortage of ADHD medications, especially mixed amphetamine salts (a.k.a. Adderall and its ilk) and methylphenidate (a.k.a. Ritalin).

The FDA website (http://www NULL.fda NULL.gov/Drugs/DrugSafety/DrugShortages/ucm050792 NULL.htm) reports that the Adderall shortages are caused by a variety of issues, mostly about "API" shortages. API stands for "Active Pharmaceutical Ingredient." According to Drug Store News more than 80% of the API needed to manufacture drugs in the US comes from OUTSIDE the United States! Most of the active ingredients come from Italy, China and India. So if the supply slows down abroad, our meds in the US are affected.

It is truly a global world of pharmaceuticals these days. The FDA requires that the API produced outside the US meet the same high standards for quality as those produced domestically. But ... and here's the shocking fact ... drugs produced overseas are NOT highly regulated, even for export to the US and other countries. As recently as 2008, there was a single FDA inspector assigned to China. As in one person. One.

OK, don't get me sidetracked into a discussion about the purity of drugs. This is about shortages. However, concerns about the purity of the API can delay production, too. The FDA took action against a Mexican API production facility in June 2011, which delayed manufacturing (this was not an ADHD drug API).

So...as of October 28, 2011, the FDA reported that Immediate Release Mixed Amphetamine Salts (Adderall and generics) are delayed because of API shortages (brand name Adderall), higher demand and manufacturing delays.

For Adderall ER, the picture is similar, but Shire Pharmaceuticals (who also produces Vyvanse) claims there is no shortage at the manufacturing level. There are some distribution inequities, though. So one part of the country might have a plentiful supply, while other areas may experience a shortage ... sigh.

Ritalin/methyphenidate - things are grim. As of October 11, 2011, Sandoz (which manufactures generic Ritalin) predicts "sporadic backorders" for the next couple of months. The only manufacturer who has plenty of generic Ritalin (methylphenidate) is Watson Pharmaceuticals which apparently has a lock on the market right now.

Metadate, a branded formulation of methyphenidate that comes in the CD, IR and ER variations, is at full supply from UCB Pharmaceuticals.
Metadate CD

The other formulation that is bountiful at the moment is Daytrana, a brand name formulation that is administered via a time release transdermal patch (applied to the skin). Noven is the manufacturer of Daytrana.

Bottom line is that some important meds are missing from our ADHD arsenal right now and nobody seems to be talking about it ... unless you are one of the unlucky ones who can't get a prescription filled.

What's your experience? Let us know where you live and whether you can get meds in your area. We need to help each other on this vital issue!

YOUR truth about stimulants

Posted on July 14, 2010 by Linda

Should you stop taking your Adderall or Vyvanse or Dexadrine now that you've heard Dr. Tracy Ware's presentation (http://store NULL.lindaroggli NULL.com/product_p/d-the%20truth%20about%20stimulants NULL.htm) about the potential dangers of amphetamines? Maybe yes. Maybe no.

I just got off the phone with a woman (let's call her "Maggie") who recently started taking Vyvanse with great success. No side effects and improved attention, etc. After she listened to Tracy's presentation, she was unnerved by the possibility of brain damage with amphetamines so she switched medications (to a second tier ADHD drug). Maggie's been in a downward spiral ever since. Missed appointments, foggy brain, battered self esteem. Nothing we aspire to, right?

So why didn't she immediately stop the new meds and go back to Vyvanse? I suspect she called me for a reality check on whether I believed amphetamines really killed off brain cells. And I do. I told Maggie that many medications have potentially serious consequences: high blood pressure medication can cause sexual problems (http://www NULL.mayoclinic NULL.com/health/high-blood-pressure-and-sex/HI00091) for men. The FDA reported today that taking a malaria drug could cause severe kidney damage (http://drugstorenews NULL.com/story NULL.aspx?id=146043&menuid=335)and heart failure. There are unintended consequences to almost every choice we make.

But also I told her that returning to Vyvanse sounded like a good idea. I'm not a medical doctor so my opinion is worth about what you pay for it – $0. But it makes eminent sense to me to stick with something that works versus flailing around trying to save your brain cells. And yes, I DO understand that salvaging brain cells is an important goal, but the jury is still out on whether those cells will regenerate or not. There is a LOT we don't know yet about the brain and how it repairs itself.

Even more important, there is a quality of life issue here. We ADD women have been through a lot of stuff (OK, sh**t) in our lives. Finding a medication that actually works to bolster our time management, organization, sense of well being, is a godsend.

We shouldn't stop exercising because we might pull a hamstring or sprain an ankle. And we shouldn't stop taking our amphetamine medication because someone told us there is potential for cell death. For heavens sake do NOT stop taking medication without telling your doctor! Those consequences could be even more dire than continuing the meds!

Anyway, Dr. Ware doesn't shun amphetamines; she prescribes them for her patients who need them. That includes those of us who don't see much improvement with Ritalin-family meds (like Tracy's own husband!).

The fact that I stopped taking my Adderall was more about looking at the factors that were causing me to feel out of control and a bit crazed. Sure there is a lot going on in my life. There is ALWAYS a lot going on in my life. And changing one thing at a time, to see the effects, is the way I can narrow down the cause of the problem, and then find my way back to a solution.

I don't know about you, but I want to feel alive every day. I want to feel good about myself and productive. I want to feel proud of myself and I'd like the people I love to be proud of me, too. It's not too much to ask of an ADD life. I know. I've lived it. And I'm going back there.

That means I will probably go back to Adderall. Not sure yet. Working on it. But if I do return to amphetamine medication, it will be MY truth about stimulants. Not Tracy's. Not Maggie's (Vyvanse is awful for me, BTW). Not Susan's or Ellen's or Mary's. Mine.

You need to find YOUR truth about stimulant medication. Yes. No. Maybe. Sometimes. Alternatives. Rotating. It's all part of the mix. If there is one thing I have learned about ADHD it's that it is literally a different experience for everyone. Personalized treatment..that's where we're headed, according to another psychiatrist who visited our Meetup group last night.

Work with your doctor, monitor your symptoms, get reaction from your loved ones. Find your OWN truth and then, make peace with it. None of us are gonna get out of this alive. Something, somewhere, sometime when we least expect it and probably don't want it, will cause our bodies to shut down and we'll bid farewell to the mortal coil.

So how do you want to live your life in the meantime? At my retreats I always read a poem by Mary Oliver (http://www NULL.loc NULL.gov/poetry/180/133 NULL.html)that ends with this line: "Tell me, what is you plan to do with your one wild and precious life?"

You alone have the answer. For all of it.

Does Ritalin make you smarter?

Posted on April 27, 2010 by Linda

Watch CBS News Videos Online (http://www NULL.cbsnews NULL.com)

Last night's broadcast of 60 Minutes (CBS) confirmed my worst nightmares: that ADHD meds will become so popular they will be treated as "brain candy" instead of as a medical necessity for people with brains like ours.

College students agreed that pill popping is rampant on campus, especially with stimulants like Adderall and Ritalin. They take them to stay up late studying; they take them to finish papers; they take them to focus on tests.

Apparently the stimulants are prescribed for truck drivers who are on the road for hours; and even doctors who work double shifts. But hey, back in my college days, didn't we do the same thing? Except the drug of choice then was No-Doz, 200 mg of caffeine concentrated in little white pills.

I went online to see if NoDoz was still around. Yep, it's still sold and it's a lot cheaper than Adderall or Ritalin. College students said Ritalin was selling for $3-$5 per pill. A bottle of 60 NoDoz costs only $9 online. Free shipping, too..

My fear is not that college students will get hooked on Adderall. My fear is that Adderall and its ilk will become so commonplace that their legitimacy as treatment for ADHD will be diminished, dismissed or even discarded.

The non-ADHD students interviewed by Katie Couric said they could focus better, they could read fine details even about uninteresting information. That's sure not what they do for the ADHD brain. I have clients who take their ADHD meds faithfully but still can't keep their attention on the chapter or the math problem or the To Do list. The pills help us pay attention; but sometimes we veer off into worlds of focus that have nothing to do with the original task.

So, let's be clear here. Just because everybody can take stimulants and gain some focus, it doesn't mean that ADHD isn't a valid diagnosis. We're out here. We still need our meds. And even if we forget to take a few each month, we shouldn't be sharing them (and especially not selling them) to all of the rest of you out there.

I guess it makes the drug companies happy. I guess students are happy and perhaps their professors.

I'm not so happy.