A year on, the national shortage of Adderall persists

AYESHA RASCOE, HOST:

The national Adderall shortage is almost a year old and there’s no end in sight. The stimulant is an effective treatment for attention deficit hyperactivity disorder – or ADHD. Doctors have had to prescribe other ADHD meds, which has resulted in shortages of some of those drugs. Patients have had to scramble to get their medications filled. They’ve had to ration their supplies or simply go without. Now, with the new school year, parents of students who need these medications to stay focused in class are particularly frustrated. To find out more about how we got here and when it will end, we’re going to talk to Dr. Mariana Socal. She’s an associate scientist at the Johns Hopkins Bloomberg School of Public Health and teaches classes on how drug prices are set. Welcome to the program.

MARIANA SOCAL: Thank you so much for having me.

RASCOE: So let’s start at the beginning. What was the initial cause of the Adderall shortage?

SOCAL: Well, part of this problem is that some products have been discontinued in the past. So we have the branded version of Adderall in the market, but also generic versions from multiple different manufacturers. And this is not a very expensive drug. And sometimes manufacturers are not paid enough, and so they may opt to exit the market. And with some manufacturers leaving and other manufacturers not having been able to increase production, what we have is a market that sometimes cannot meet the full demand of the children and adults who need it.

RASCOE: And so after nearly a year, our – it seems like we’re no closer to solving this problem, or are we?

SOCAL: Yes, so this whole market is very fine-tuned to the purchases that are made and to the inventory levels that are maintained. And these inventory levels all of a sudden may not be enough for the demand, you know, at the beginning of the school year and etc. I would like to mention that basically all our pharmacies, they all purchase from three large wholesalers. They concentrate over 90% of all the drug transactions. So the manufacturers, really, they fine-tune their production to how much each of these three wholesalers is purchasing from them at any given point in time.

And for the manufacturers, if they want to increase production, they need, sometimes, approval from the FDA if they want to use a different facility, for example. Typically, they don’t have a lot of extra manufacturing capacity in standby. And these are controlled substances, so there’s also quotas in how much each manufacturer is allowed to produce. So there’s multiple factors there that impact each particular manufacturer’s ability to foresee and predict how much of that drug will be needed.

RASCOE: So what would be the solution to these shortages? And is there any movement at this point to try to address the problem?

SOCAL: Well, on the long run, what we would need is a better surveillance system that captures situations where there is a sudden increase in demand for whatever products, and that increase in demand is greater than the levels that manufacturers are able to produce at that point in time. So today, we’re very attuned. We have a good surveillance system for problems that happen in the manufacturer side. The FDA has a series of tools at their disposal to mitigate a shortage and sometimes even prevent it before it happens. But when it’s the case of an increased demand, especially a sudden one and a fast-growing one, then we don’t really have a good surveillance system.

RASCOE: In the meantime, what should patients do if their Adderall and the Adderall alternatives that they need are out of stock?

SOCAL: Well, I would advise, No. 1, that they go to their preferred pharmacy where they typically go, see what alternatives are available and communicate with their providers to check if these alternatives are appropriate for their case. The opposite can also happen, asking the provider which alternative formulations or products could be used and then checking with the pharmacy if any of those is currently available.

RASCOE: That’s Mariana Socal, an associate scientist at the Johns Hopkins Bloomberg School of Public Health. Thank you so much for joining us.

SOCAL: Thank you so much for having me.

(SOUNDBITE OF WILL VAN HORN’S “ALBERTO BALSALM”)

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