attention deficit disorder

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Where Have All The ADHD Drugs Gone? Patchy Shortages Abound

The other day, my friend went in to a suburban Boston CVS to fill the regular prescription for Ritalin that helps her focus and keeps her attention deficit disorder at bay.

But the pharmacist sent her away empty-handed, saying that the store had not been able to get the generic drug in months and did not know when that would change.

“The pharmacist said that all the area CVS’s were out of it, along with Adderall and similar drugs,” my friend reported. Later, when she called around, she found odd clumps of supply: One store might have the generic but not the brand-name, or vice versa. Maybe, the pharmacist told my friend, she should try getting farther out of the city, away from the Boston colleges whose students generate high demand.

But it’s not only a college-area problem. There are patchy reports of drug stores around the state running out of ADHD drugs for children and adults (see our follow-up post here), and the FDA has just posted several new ADHD drugs on its national list of medications in short supply.

In Michigan, pharmacists say the shortage is among the worst drug dry-ups they’ve seen, according to this television report about disappointed customers who break into tears; and in Washington, D.C., some expect shortages to last until January at least, according to local reports.

Critical shortages of scores of important medications, including chemotherapy drugs, have been building for months, to the point that President Obama issued an executive order aimed at alleviating them earlier this week.

But those shortages tend to revolve around intravenous drugs with such low profit margins that manufacturers have little incentive to make them. (See NPR’s Dick Knox on the issue here.) They don’t tend to concern pills that, whether generic or brand-name, are blockbusters any way you look at them in a country where 9 percent of the children are diagnosed with ADHD.

So what’s happening? Has demand simply risen beyond drugmakers’ capacity as all those diagnoses have been made? On the FDA Website, rising demand is one of the reasons given for the shortages. But it may be more complex than that.

When I think ADHD, I think Dr. Edward Hallowell, a leading authority on the topic who writes books and runs treatment and education centers. Yes, he told me, over the last several weeks, he has heard from some patients that they have been forced to search from pharmacy to pharmacy for the ADHD medication Adderall.

“Just this morning, I changed someone’s medication because they were having such trouble finding it,” he said. “It seems crazy to me, and I don’t know what to tell my patients other than, I guess, ‘Go shopping,'” he said.

A drug representative for Shire Pharmaceuticals, a company known for ADHD medications among others, told him recently that the shortage is the result of federal quotas on how much of the drugs can be made, Dr. Hallowell said.

“I honestly don’t know, but I think that’s the answer,” he said, “and it just seems bizarre that they put a quota on it. I don’t understand the rationale behind that: If a medication is prescribed, it should be prescribed.”

Quotas? Continue reading

Study: Use Ritalin To Wake Patients Up Sooner After Surgery?

Ritalin is famed as a drug for Attention Deficit Disorder, but a new study in rats suggests that its effects on the brain’s arousal circuits could also be used to wake patients up sooner after surgery.

Why bother? Several reasons, from saving health care money to possibly reducing post-operative delirium.

Dr. Emery Brown, a neuroscientist and anesthesia expert at MIT, Harvard and Massachusetts General Hospital, explains the new research, led by Mass. General’s Dr. Ken Solt, just out in the journal Anesthesiology. He is a co-author on the paper.

This is a major new result because it shows that we can wake the brain up from general anesthesia. Currently at the end of surgery, the anesthesiologist just lets the anesthetic drugs wear off and the patient regain consciousness.

We decided to study the possibility of devising a strategy to wake patients up from general anesthesia. In this paper we show that it is possible to administer to rats methylphenidate (Ritalin) -— the same drug that is used to treat attention deficit hyperactivity disorder (ADHD) in children. This drug actively induces emergence of the animals from general anesthesia.

‘This is an exciting experimental finding that has to be replicated in humans.’

It is not that the anesthesia is being reversed. Rather the arousal pathways, most likely the dopaminergic and noradrenergic pathways, are being activated to allow the brain to overcome the effects of the general anesthesia and the animal to awaken. It is known that Ritalin blocks the reuptake of dopamine to maintain the brain levels of this excitatory neurotransmitter.

This is an exciting experimental finding that has to be replicated in humans. If this pans out, it could change anesthesiology practice by initiating use of a drug that is already known to be safe to actively induce emergence from general anesthesia.

This would have important implications; possibly reducing cognitive dysfunction in the elderly and delirium in children after general anesthesia. Continue reading