The following is a personal essay reflecting the opinions of the author.
It began with an Adderall shortage in 2022. Today, prescriptions for many stimulant medications used as the first-line treatment of ADHD are consistently and frustratingly difficult to fill. So it’s unsurprising that ADHD features prominently in the majority of public comments submitted to the Federal Trade Commission (FTC) by stakeholders impacted by long-term medication shortages involved in the treatment of many conditions, including cancer. ADHD patients demand attention on their suffering.
But, by inviting public testimony on the stimulant shortage and pharmaceutical practices, I believe the FTC is only trying to find cover for the Drug Enforcement Administration (DEA). The DEA is the only governmental agency that sets production and distribution quotas for every drug company manufacturing controlled medication. The DEA decides how much of each medication can be released to pharmacies in any given month. Therefore, this problem traces its roots and long tendrils back to the DEA alone. No other agency has the authority to create and prolong it.
The DEA meets with every company that markets a controlled substance each March and April to determine how much of that company’s product can be released each month in the following calendar year. This process tries to predict in March of 2024 how much medication will be needed 21 months later in December of 2025. It is a crude and inadequate system that the DEA is too inflexible to relinquish.
For as long as the United States government has wrestled with combatting the distribution and use of illicit drugs, the DEA has used only one tactic — restricting the amount of drugs available to be sold legally. Now, the DEA is using the same playbook for ADHD stimulants.
Two years ago, the DEA decided that ADHD stimulants were being diverted and abused on a large scale, though there was virtually no evidence to support this belief. Studies have shown that a number of people (statistics vary) try stimulants but do not continue to take them without a prescription. About 90% of the diverted immediate-release stimulants are used by a narrow demographic: white male college students who use the drugs so they can stay awake. The medications are not being abused by people with ADHD, many of whom consider the drugs a lifeline for daily functioning.
[Read: Call to Action! Speak Up to End the ADHD Drug Shortage]
The DEA’s skepticism also came on the heels of increased rates of ADHD diagnosis and as a response to online providers who were sloppy about prescribing ADHD stimulants during the pandemic. The online clinics, however, never accounted for more than 1% of all prescriptions issued. And that problem was solved more than two years ago.
The DEA also observed that the number of people taking ADHD medications had been growing by 10% a year for 15 years. The growth rose largely from adults being diagnosed in later life. The relative number of children and adolescents taking stimulants has not changed in 20 years.
The DEA’s apparent logic behind its sweeping decisions was that these adults were abusing prescription stimulants, disregarding the well-documented evidence that ADHD persists after childhood. The rate of diagnosis and medication treatment is rising faster in every European country as well. In the last year for which I had access to the drug company marketing studies (2014), the average age of diagnosis of ADHD was 31.
The DEA does not bother with facts. Its answer to this increased level of prescriptions: Decrease the amount of drug available regardless of consequences. Even when it became abundantly clear that placing quotas on drug companies had been a disastrous decision, the DEA did not reverse course. Even if the DEA decided in April to raise the allotments of drugs released to pharmacies, its current flawed and inflexible distribution mechanism would not allow for an increase until January 2025.
[Download: The Ultimate Guide to ADHD Medication]
I strongly suspect that the FTC is looking for an agency other than the DEA to blame. First, it said the drug companies were not making enough medication. But the drug companies were making and distributing as much as the DEA allowed them to. The idea that the drug companies were forgoing billions of dollars of profit was always unbelievable. Then the blame was laid on raw material shortages, but after two years, that explanation became hard to believe as well.
Then the FTC, FDA, and DEA blamed the telemedicine-only clinics that sprang up during the pandemic. However, the bad actors in this area have all closed down. Still, there has been no improvement in the shortage.
The time has long since passed for the DEA to admit its fault and fix its broken quota system. There has already been too much needless suffering by innocent people who did nothing to cause the DEA’s restrictions.
The deadline to submit public RFI comments to the FTC and U.S. Department of Health and Human Services (HHS) is May 30, 2024. Add your testimony at www.regulations.gov. (Direct link to the comment section)
The public can also demand an end to the ADHD medication shortage by writing letters to representatives, the DEA, and the FDA using templates provided by ADDitude.
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