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Transcript

What's Behind the Adderall Shortage? · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: The Adderall shortage is making life tough for patients and families that rely on the medication to treat attention Deficit Disorder or ADHD.
• 0:09
  David: This huge rise in ADHD diagnosis and in prescribing via telemedicine during the public health emergency seems to be driving the problem, and manufacturers have also had a few supply hiccups.
• 0:19
  David: The federal government was getting ready to dial back the availability of controlled substances via telemedicine.
• 0:25
  David: But after receiving literally tens of thousands of comments, they've decided to keep the pandemic ever rules in place for at least another six months.
• 0:34
  David: Why is there an Adderall shortage?
• 0:36
  David: When will the Adderall shortage end?
• 0:38
  David: And is ADHD ever an advantage?
• 0:40
  David: Welcome to CareTalk America's home for incisive debate about healthcare, business, and policy.
• 0:46
  David: I'm David Williams, president of Health Business Group.
• 0:49
  John: And I'm John Driscoll, the president of Walgreens Health.
• 0:52
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• 0:56
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• 0:57
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• 1:01
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• 1:08
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• 1:12
  John: So, David, why are we talking about Adderall at all?
• 1:17
  David: Well, John, you know, a lot of people, I mean, most people say, you know, why is there an Adderall shortage as opposed to why are we talking about it at all?
• 1:23
  David: And the really, the reason is twofold.
• 1:24
  David: I mean, is supply and demand, right?
• 1:26
  David: The main reason here seems to be demand.
• 1:28
  David: Why is there more demand for Adderall?
• 1:30
  David: Mainly because there's been a big increase in the, uh, diagnosis of ADHD, especially during the pandemic.
• 1:36
  David: It's also now, uh, women and girls, uh, have the diagnosis wasn't, uh, not just male as it has been in the past.
• 1:42
  David: Um, and in fact, John, there's been a 58% increase in patients age 22 to 44 from 2018 to 2022 versus a 35% increase for Adderall over time at that same time.
• 1:55
  David: So there's a lot of people taking it, a lot of, uh, a lot of adults with prescriptions.
• 1:59
  David: You're, you, you, you, with all your
• 2:01
  John: statistics, shouldn't we break this down into basics, David?
• 2:04
  John: I mean, what is Adderall after all?
• 2:06
  John: I mean, it's a, it's a drug.
• 2:08
  John: That is prescribed by doctors for people with attention deficit and hyperactivity disorder, which is kind of a cluster diagnosis, which has been growing like crazy.
• 2:19
  John: That in I think, increases the amount of dopamine and no, no neuro epinephrine into the brain of from the brain to sort of sort of, sort of in.
• 2:29
  John: Increase the reward functions to help people who the drug could help focus a bit more at a period of time when our entire culture is suffering from, um, attention overload and lots of sort of the digitalization of our everyday life.
• 2:47
  John: Um, and I think that the, the, that Adderall is one of a, a, a family of.
• 2:54
  John: Stimulants really, that are used pretty, that, that appear to be prescribed pretty liberally by doctors, um, to people like you who have a hard time focusing on one thing at a time,
• 3:08
  David: just prescribed to people like everybody, you know, not just to me.
• 3:11
  David: Um, there is, so there's the demand side.
• 3:13
  David: There's a bit on the supply side as well.
• 3:15
  David: Um, one of the main manufacturers, which is Teva, had some hiccups along the way before, uh, some of the manufacturers have blamed actually the dea, uh, which gets involved because it's a controlled substance, um, because there's actually a quota, uh, of, of the, uh, active, uh, ingredient that goes to the manufacturers.
• 3:33
  David: But DEA says that's, that's not true.
• 3:35
  David: The companies actually aren't using their whole quota.
• 3:37
  John: But how, how big a problem is this?
• 3:40
  John: A D H D thing?
• 3:41
  John: The, the attention hyperactivity disorder stuff, it
• 3:46
  David: seems, I mean, it seems to be a big problem, John.
• 3:48
  David: I know that, uh, you know, as a father of kids, uh, many, many, uh, kids in school are taking medication and sometimes the, uh, the teachers or the school actually, uh, ask people to be tested and to be, and to be taking it.
• 3:59
  David: So it's, it's pretty common.
• 4:01
  David: I know it's a big problem, John, that there's the shortage.
• 4:04
  David: Um, you know, uh, what's happening now is you've got some people who can't get it.
• 4:07
  David: They can't refill it.
• 4:08
  David: Now, that causes a stress and anxiety.
• 4:10
  David: Uh, they have to drive further to find it and to go without their medications.
• 4:14
  David: And so, you know, not having it could impact somebody's ability to learn, to work, to socialize
• 4:18
  John: John.
• 4:18
  John: So it's a, it's, yeah.
• 4:19
  John: No, I, and I, and I, and I, and I think that there is, yeah, attention deficit is a real thing.
• 4:27
  John: You know, I know that, you know, I, I've known kids who have been prescribed it, and it could substantially help them focus in a way that they couldn't otherwise get through a structured day without it.
• 4:39
  John: So for those parents, particularly with kids who have a hard time focusing, although it's a it, it's a lifetime diagnosis.
• 4:49
  John: Potentially that, that this is, this drug is a lifesaver or a, like life co complicator if it's not available.
• 4:56
  John: So we have gotten gone from a period of, of, of o, of oversupply, I guess, during the pandemic.
• 5:04
  John: Um, to one of Undersupply cuz there's, there's complaints up and down the chain.
• 5:07
  John: Where do you think the problem's, biggest problems are in terms of supplying and meeting the needs of those parents and children who need this drug?
• 5:17
  David: So, John, uh, one of the things is, you know, you gave me a hard time about statistics before, so I, I won't make statistics, but this is a statistically based observation.
• 5:25
  David: They say that actually there's more adults with prescriptions for Adderall than there are people diagnosed.
• 5:31
  David: With a d h D.
• 5:33
  David: So that means that, you know, a lot of people are getting it, so there's a lot of demand for it, including off-label or undiagnosed, uh, use.
• 5:39
  David: I think it is mostly about just a rising demand, which had to do with the pandemic and also has to do with the idea, hey, it's not just for kids anymore.
• 5:48
  John: Well, I think, I think that there's a, it, it is effectively, uh, you know, a critical drug for a lot of kids to get through the day, particularly as they're getting through adolescence and all these other things that are driving them.
• 6:01
  John: About having a bounce around, uh, uh, you know, off the walls when they're kids.
• 6:05
  John: The, the, the, the, the thing about an a drug that can help you focus, whether it's coffee or, or something that's prescribed, is it's gonna be popular, particularly in a culture that's getting over.
• 6:18
  John: Supplied with stimulants and distracting stimulants.
• 6:22
  John: And you know, I know that at Medco at one point it looked to us as if some of the parents were, uh, filling their kids prescriptions and probably borrowing a few pills here and there.
• 6:31
  John: It sounds like more and more of that is happening because the reality is as a stimulant it will allow you to kind of stay up longer and potentially focus.
• 6:41
  John: And the use of stimulants was probably.
• 6:43
  John: Started by the military, uh, in the Second World War and has continued to kind of seep into everyday life, particularly as a productive stimulant to help kids focus.
• 6:56
  John: But it is, but it is sort of an epidemic.
• 6:58
  John: I mean, I, we are, in addition to it, having an epidemic of, of attention, a, a attention distraction.
• 7:06
  John: We are seeing an epidemic of prescription in this area.
• 7:08
  John: I mean, it, it is that number of adults.
• 7:11
  John: Taking it versus having a diagnostic identification that they need.
• 7:17
  John: It is sort of scary.
• 7:19
  David: John, speaking of the military, there was actually an interesting change in military policy I read about in the Wall Street Journal, which is that, uh, A D H D diagnosis is no longer disqualifying for someone, uh, to be recruited into the military.
• 7:33
  David: There was an interesting article and, and the re main reason for that is probably.
• 7:37
  David: Uh, they're just trying to do recruitment and they don't wanna, you know, unnecessarily, uh, make the pool too small, especially with all these DESE no seizure that are out there.
• 7:45
  David: There was an interesting letter to the editor from a pediatric, uh, neurologist, a scientist who actually said, well, you know, it's good that the military is letting people in, but also A D H D may actually does have a benefit for certain jobs and is giving the, uh, the example of a, of a hunter.
• 8:01
  David: Somebody that actually could be hypervigilant and notice a small change.
• 8:04
  David: And there's obviously applications for that in the military, but John, a lot of jobs actually, I see a lot of very successful adults, nevermind, you know, struggling kids in adolescence.
• 8:12
  David: As, as you'd said, there's jobs that require kind of an awareness of opportunity and danger.
• 8:17
  David: A lot of people in venture capital or trading, or people in high tech that actually have ADHD and actually find a way in adulthood, uh, to not just conquer, but actually maybe to use it as a, as a benefit.
• 8:30
  David: So, We're not clinicians, John, at least I'm not.
• 8:32
  David: Maybe you got a degree since we spoke, but you know, one of the things is that having a restricted supply, you know, maybe some people won't, uh, won't use it and they'll find they don't wanna refill
• 8:40
  John: it again.
• 8:41
  John: Well, one of the challenges in the restricted supply, which hopefully will sort itself out is there were these effectively pill mills on the OR, or those who've been, who've been, uh, uh, uh, criticized as potential pill mills.
• 8:54
  John: Some of the online pharmacies were.
• 9:00
  John: Based on what, what what has been reported, really, very, uh, uh, uh, there, there was scant attention paid to whether people actually needed these bills.
• 9:12
  John: And if you looked at the proportion of the population versus those who were going to some of the online sources where they would Google the how to get it and call up someone that the.
• 9:24
  John: Online pharmacies, which have now been shut down or at least investigated by the DEA, are substantially restricting what they they used to do, which is to kind of pass out those prescriptions pretty easily.
• 9:36
  John: I think hopefully that will start to slow down the, the overprescribing or the demand side that a, allow the kids who really need it to get access to it.
• 9:47
  David: Well, John, I'm not sure about that, you know, because I'm not sure about whether.
• 9:51
  David: Uh, it is gonna go back to how it was because, uh, before the pandemic, about 2% of stimulant prescriptions were from telemedicine.
• 9:59
  David: And as of 2022, it's actually 40%.
• 10:02
  David: A big reason for that is the f d a waived this requirement to have an in-person evaluation for controlled substances.
• 10:09
  David: Now, there's arguments, uh, for doing it, you know, it's convenient.
• 10:12
  David: Uh, the provider can actually see, theoretically the patient in their home and, you know, see what they're doing.
• 10:17
  David: So there's some use cases for it, but there's probably been a good amount of, of abuse, at least alleged and.
• 10:24
  David: The FDA was planning to actually tighten the controls a bit, and that was supposed to coincide at the end of the public health emergency in mid-May.
• 10:31
  David: However, they got so many comments, 38,000 comments, John, that they actually decided to extend the full flexibility for another six months or so.
• 10:39
  David: And well, I
• 10:40
  John: think I, I, I, I think to be fair to the people who are criticizing the act, there is a, there, the, the bad actors in this area are alleged to have been.
• 10:52
  John: Spending a lot less time on counseling and evaluation and a lot more time just taking that prescription, taking the request, and filling the prescription.
• 11:00
  John: And that's not what the point of this is.
• 11:01
  John: I mean, these stimulants are, are pretty, are they?
• 11:04
  John: They, they do stimulate a lot of things.
• 11:07
  John: They can lead to heart problems, dizziness, stomach problems, uh, sleep problems.
• 11:13
  John: I mean, they're, if they're improperly prescribed or it's not a good fit, they're not a, uh, heads eye win, tails, eye win kind of proposition.
• 11:22
  John: They definitely jack up certain processes in the body that, in the wrong, in the wrong population can lead to kinda a serious illness.
• 11:30
  John: And so the, the, the challenge to evaluate is still there.
• 11:36
  John: Uh, but I, I get the fact that we need to not go completely backwards in terms of convenience cuz the, the healthcare system is not anything but, but I do welcome.
• 11:47
  John: The deas, uh, and, and public health authorities really kind of overseeing this to make sure that the right drugs are getting into the.
• 11:55
  John: The right hands.
• 11:56
  John: But I mean, David, is it a bad thing that all these adults, I mean assuming that they could do it without damaging their health, are using performance enhancing drugs?
• 12:05
  John: I mean, we, we allow them to drink coffee.
• 12:06
  John: I mean, what's the downside there?
• 12:08
  John: Yeah.
• 12:09
  David: I can't comment from a clinical standpoint, Sean, but I would say that, uh, it's good to have more access to things that are going to work, and we have to assume that if there's diagnosis being made by.
• 12:19
  David: A physician that that is a right diagnosis for somebody and that treatment is going to be helpful.
• 12:25
  David: So in general, I'm in favor of, uh, Of broader access.
• 12:28
  David: It's just notable, you know, just how much of an increase there is.
• 12:32
  David: And when we, we've been talking very much about, you know, Adderall, but there's other controlled substances that are also, um, available through telehealth and, and the prescriptions for those has gone up.
• 12:42
  David: Um, you know, a lot as well.
• 12:43
  David: And I, if you look at it, it's one thing if there's a physician, you know, and they make a diagnosis and then they, they prescribe something.
• 12:50
  David: If it's another thing that if you come with not just your diagnosis, but your prescription that you want and you call a doctor to get that, there's something wrong with a business.
• 12:56
  David: John, that does, uh, does that, I'll make, I'll make that so, so,
• 12:59
  John: so David, you're, you're a, a worry parent and you want to get access to a drug that may or may not be, but could be soon or was recently in short supply.
• 13:09
  John: What does a parent do if they're worried about this?
• 13:12
  David: Well, I'll tell you what pe what, what people have been advised, uh, to do, uh, on this, which is first of all, um, you know, to get the, um, to, to, to fill the prescription, uh, a little bit early, you know, so I know my own kids sometimes they'll tell me, oh yeah, can I get a refill?
• 13:29
  David: And it's, they're already out.
• 13:30
  David: Uh, at that time, not, not necessarily for this medication, but for, uh, for others.
• 13:34
  David: There's also other stimulants you mentioned caffeine, which is certainly not in short supply.
• 13:39
  David: Uh, but there's other stimulants and people have been asking their physician about what
• 13:42
  John: to do.
• 13:43
  John: Other prescription stimulants, other prescription
• 13:46
  David: stimulants.
• 13:46
  David: That's right.
• 13:47
  David: So it's not just Adderall that's available.
• 13:49
  David: Um, and then, uh, you know, a broader call, you know, call your electric representative and, uh, tell 'em to, uh, tell 'em to do something about it.
• 13:56
  David: And that's, that's what people are doing.
• 13:58
  David: Yeah.
• 13:58
  John: Yeah, I, I think that this is a case where you want to be aggressive about calling your a representative, talking to your doctor, trying to get ahead of it.
• 14:07
  John: I, I, what I, what I hear about and read about is that in some cases there, this drug is still in short supply and I think we've changed with that many adults actually using.
• 14:18
  John: Performance enhancing drugs?
• 14:19
  John: I don't, I don't think we're going backwards on that, so I think the demand is gonna stay up there, but, but people want to be super careful that for they or their children, that they're getting the right ev, Eva, you know, physician's clinical evaluation to make sure that it, it's doing more good than bad and people understand what the downside consequences of it are.
• 14:38
  John: I think we're, we definitely, we don't always necessarily want broader access, but we want easier access for those simpler, more convenient.
• 14:47
  John: More access for folks who have otherwise have a really hard time getting the drugs they need from their, their, from their docs and, and clinicians.
• 14:55
  John: Um, I, I think it's, we're, we're sort of in this interesting period, David, where I think a lot of adults ha have, have gotten onto these stimulants and find that they're helpful to them.
• 15:07
  John: That's created the demand shortage.
• 15:10
  John: And I, I, although I think we can solve the demand shortage, I think we're in a new age.
• 15:14
  John: Of, you know, prescription performance enhancing drugs.
• 15:17
  John: That is, it's just something we ought to be thinking about, particularly in under the, the, with the risk of the long-term consequences.
• 15:24
  John: Cause each one of these prescription substances is, you know, it's, it's a pretty powerful stimulant for the body.
• 15:29
  David: Well, that's it for yet another episode of CareTalk we've been talking today about ADHD, Adderall and how it all adds up.
• 15:36
  David: I'm David Williams, president of Health Business Group, and
• 15:39
  John: I'm John Driscoll, the president of Walgreens Health.
• 15:41
  John: If you liked what you heard or you didn't, please subscribe on your favorite service.