Adderrall nationwide shortage - has this affected you?

[Fluidity of Movement]

I've been seeing a lot of buzz online lately of Adderrall shortages, and have talked to some people who are really concerned that they may have to come off stimulants altogether. One person claimed their doctor didn't want to change their prescription at all.

Has this affected your practice at all (have a lot of people come to you asking for changes)? Are you concerned about having to switch someone to Ritalin / Concerta / etc? Would that be difficult to manage in dosing / sides?

Just curious, thank you for your time.

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[hippopotamusoath]

I feel nothing about this, it is what it is. I tell my patients there is a shortage. If they have problems getting their stimulant, we switch to another drug, another formulation, or another pharmacy.

I'm a big believer in finding and treating ADHD in adults, and at the same time I find the patient population and the treatment protocol to be highly annoying. I do the best I can for the patients with the resources I have available. This shortage is no different...

 

[allantois]

It’s an absolutely nightmare and it’s not just an Adderall shortage. It’s also a lot of methylphenidates now too (since well, that’s what we switched the Adderall patients too) and now kids can’t get their Concerta.. I offer to switch patients to the new/expensive stuff like Vyvanse/Adzenys/Mydayis if appropriate. Either their insurance covers it or they have to self-pay or they have to suck it up or we can try non-stimulants

 

[clausewitz2]

Don't forget good old-fashioned Dexedrine as a possible substitute.


...just don't order Desoxyn by mistake.

 

[littlefred]

In my part of the country, all of the patients that have a legitimate RX for mixed amphetamine salts have tested positive for methamphetamines (no desoxyn on PDMP). 100%. No joke. Peeps handing out Adderall don't even bother to fo UDS on their patients.

I wish they moved amphetamines to schedule I. Too abused and prescribed like candy. Same as MDMA in the past. DEA take note.

 

[allantois]

In my part of the country, all of the patients that have a legitimate RX for mixed amphetamine salts have tested positive for methamphetamines (no desoxyn on PDMP). 100%. No joke. Peeps handing out Adderall don't even bother to fo UDS on their patients.

I wish they moved amphetamines to schedule I. Too abused and prescribed like candy. Same as MDMA in the past. DEA take note.

I do often think about this. Adderall is largely illegal in most of the world. People seem to manage fine there

I found this map online:



I see a lot of patients from Europe and South America. The only ones who come to me on Adderall are from Brazil. My understanding is that it is prescribed in some countries in Europe, however, extremely rarely

 

[clozareal]

I've had to counsel patients and their parents (for kids) on stimulant withdrawal if they can't get their Adderall in time and have to be without for a few days while the pharmacy finds it.

I've also had more annoying phone calls from the pharmacy that I have to manage. I often tell the patient to call around and ask themselves because I've wasted my time doing so too often, but some pharmacies don't like that because they don't want to reveal their controlled substances supply.

I've switched patients to all kinds of different stimulant medications because Adderall, Vyvanse, Concerta, and Ritalin are out. Thankfully I learned how to use much of them during my CAP fellowship except for the newest ones like Asztarys.

 

[TexasPhysician]

It’s an absolutely nightmare and it’s not just an Adderall shortage. It’s also a lot of methylphenidates now too (since well, that’s what we switched the Adderall patients too) and now kids can’t get their Concerta.. I offer to switch patients to the new/expensive stuff like Vyvanse/Adzenys/Mydayis if appropriate. Either their insurance covers it or they have to self-pay or they have to suck it up or we can try non-stimulants

Concerta is having its own legal battle. OROS generics have been discontinued.

 

[TexasPhysician]

In my part of the country, all of the patients that have a legitimate RX for mixed amphetamine salts have tested positive for methamphetamines (no desoxyn on PDMP). 100%. No joke. Peeps handing out Adderall don't even bother to fo UDS on their patients.

I wish they moved amphetamines to schedule I. Too abused and prescribed like candy. Same as MDMA in the past. DEA take note.

I’m addictions and have UDS on many patients on Adderall. I don’t see it causing a positive methamphetamine result.

If it did, I’d suspect a poor quality test as false positive. Confirmatory testing would confirm.

 

[littlefred]

I’m addictions and have UDS on many patients on Adderall. I don’t see it causing a positive methamphetamine result.

If it did, I’d suspect a poor quality test as false positive. Confirmatory testing would confirm.

I work on an OTP clinic here in TX. PDMP reviews show Adderall RX for the patients I'm referring to and we do confirmatory testing for amphetamines at our clinic. That's where I'm seeing methamphetamines.

I was referring to the prescribers out there that don't even bother to do drug testing. Seems like you are doing your job correctly by testing.

 

[TexasPhysician]

I work on an OTP clinic here in TX. PDMP reviews show Adderall RX for the patients I'm referring to and we do confirmatory testing for amphetamines at our clinic. That's where I'm seeing methamphetamines.

I was referring to the prescribers out there that don't even bother to do drug testing. Seems like you are doing your job correctly by testing.

So you are saying confirmatory testing shows both Adderall and methampetamine, and you think the Adderall is causing the + meth rather than the patients using meth as well? Or are you saying patients that use meth are drawn to Adderall?

 

[littlefred]

So you are saying confirmatory testing shows both Adderall and methampetamine, and you think the Adderall is causing the + meth rather than the patients using meth as well? Or are you saying patients that use meth are drawn to Adderall?

Hey, I'm also addiction trained so I know how to interpret UDS or at least I hope I do.

What I'm saying is that have all the patients that I have seen in my area that have a legitimate Adderall RX are also coincidentally testing positive for methamphetamines (quantitative testing/confirmatory testing) in my clinic. So they have a stimulant use disorder and their prescribers are clueless because they are not urine drug testing (my assumption) or don't care.

Does that make sense?

 

[Old&InTheWay]

In my part of the country, all of the patients that have a legitimate RX for mixed amphetamine salts have tested positive for methamphetamines (no desoxyn on PDMP). 100%. No joke. Peeps handing out Adderall don't even bother to fo UDS on their patients.

I wish they moved amphetamines to schedule I. Too abused and prescribed like candy. Same as MDMA in the past. DEA take note.

If it's 100% there is either something wrong with the lab or there is meth in the adderall. Highly unlikely that every person prescribed adderall in your part of the country is using meth.

 

[TexasPhysician]

Hey, I'm also addiction trained so I know how to interpret UDS or at least I hope I do.

What I'm saying is that have all the patients that I have seen in my area that have a legitimate Adderall RX are also coincidentally testing positive for methamphetamines (quantitative testing/confirmatory testing) in my clinic. So they have a stimulant use disorder and their prescribers are clueless because they are not urine drug testing (my assumption) or don't care.

Does that make sense?

Sorry, I misinterpreted. Like the other poster, I thought you were saying this was a false positive issue or contamination issue.

 

[clozareal]

Hey, I'm also addiction trained so I know how to interpret UDS or at least I hope I do.

What I'm saying is that have all the patients that I have seen in my area that have a legitimate Adderall RX are also coincidentally testing positive for methamphetamines (quantitative testing/confirmatory testing) in my clinic. So they have a stimulant use disorder and their prescribers are clueless because they are not urine drug testing (my assumption) or don't care.

Does that make sense?

A positive urine drug screen for methamphetamine doesn't mean they have a stimulant use disorder.

For me, I treat mainly CAP. I'm not going to drug test the children I treat, but I will for my teens and adults. I haven't seen meth use since graduating from fellowship in my PP population.

 

[clausewitz2]

If it's 100% there is either something wrong with the lab or there is meth in the adderall. Highly unlikely that every person prescribed adderall in your part of the country is using meth.

That said, he is working and seeing this in a somewhat addiction-enriched environment.

 

[Stagg737]

It's been a massive headache for me in my rural telehealth clinic. I've got patients who have been stable on their meds for years (a couple for decades) who are now only able to get 10-15 pills because the pharmacies are running out. Next nearest pharmacy with a supply is 50+ miles away and they'll tell me they can only do a partial fill by having the patient take 2 10mg tabs because they don't have 20mg tabs. It's a shame because the difference for some of these patients is night and day and when they don't have the med their presentation in the appointment would be obvious to a 10 year old.

 

[Old&InTheWay]

That said, he is working and seeing this in a somewhat addiction-enriched environment.

That's fair, and it wouldn't surprise me if many or even the majority of people were also using meth. It's the fact that it's 100% that is suspicious.

 

[annoyedpsychiatrist]

its a massive issue for me as well. The reality is I really try to be objective with who I have on stimulants, i dont put clearly inappropriate patients on stimulants so the ones who are using it have had drastic improvements in occupational, educational, or social domains. Then sometimes insurance limits alternative options. The adderall shortage leads to stuff prescribed to compensate, which furthers shortages of those meds.

But all the time I see inappropriate patients on stimulants which is laughable. I had an intake where the guy wanted me to continue his adderall. He was getting adderall 20mg four times a day. He didnt work/wasnt in school. On disability for unclear reasons. Strong hx of substance use. He used it because it "gave him the energy he needed to enjoy his day properly". I had a 72 year old guy come in and he had been getting adderall XR 40mg BID and he had history of heart issues in the past.

so yeah, too many idiot prescribers

 

[calvnandhobbs68]

Yeah I think this is perpetuated by the fact that Adderall seems to be the only stimulant that a whole slew of physicians even know how to prescribe for some reason.

Adzenys is having a good old time with this (they even promote it on their website with a popup like "here about the adderall shortage??"). If you can get people to fill it at one of the AytuConnect pharmacies, max they'll pay even if insurance doesn't cover is $35/month which isn't bad.

And yeah Concerta is about to be a mess too as the only OROS authorized generic just stopped being produced suddenly. Cotempla is also a very long acting option there (has the same Aytu deal as above) but I've also swapped people over to Ritalin LA who have done fine. It also tends to be specific doses so pharmacies will have 27mg but not 36mg, so if they can tough it out for a month on 27mg I'll just do that.

 

[Merovinge]

A positive urine drug screen for methamphetamine doesn't mean they have a stimulant use disorder.

For me, I treat mainly CAP. I'm not going to drug test the children I treat, but I will for my teens and adults. I haven't seen meth use since graduating from fellowship in my PP population.

Depends on the location/pt population. Around me most of the methamphetamine usage is restricted to small very low SES areas and incidentally the LGBTQ+ scene. However where I did med school it was much more common, just the geographic spread of street substances.

 

[Merovinge]

And yeah Concerta is about to be a mess too as the only OROS authorized generic just stopped being produced suddenly. Cotempla is also a very long acting option there (has the same Aytu deal as above) but I've also swapped people over to Ritalin LA who have done fine. It also tends to be specific doses so pharmacies will have 27mg but not 36mg, so if they can tough it out for a month on 27mg I'll just do that.

Very sad to hear this is going to be a mess. I can think of almost no case where I would use an ER Ritalin when Focalin XR is covered by every insurance I have run into including my states medicaid. It's a great drug for so many reasons (sprinkles if unable to swallow, 50/50 release, tolerability, least adrenergic of all psychostimulants) and not a huge deal to do Focalin XR and then 1/2 that dosage IR around 1500h if needed.

 

[calvnandhobbs68]

Very sad to hear this is going to be a mess. I can think of almost no case where I would use an ER Ritalin when Focalin XR is covered by every insurance I have run into including my states medicaid. It's a great drug for so many reasons (sprinkles if unable to swallow, 50/50 release, tolerability, least adrenergic of all psychostimulants) and not a huge deal to do Focalin XR and then 1/2 that dosage IR around 1500h if needed.

Oh yeah I'll swap into Focalin too...I mean Ritalin LA is all basically the same thing (50/50 pulse, sprinkle beads) but might get a longer effect time with Focalin. Which isn't always great with younger kids who get all the appetite suppression and insomnia from stimulants, so I'll often start out with Ritalin LA in younger kids but it's like 6 of one, half dozen of the other.

 

[MacDonaldTriad]

This is great. The less doctors that can push speed the better. This may be the best thing that will help psychiatry gain ground with the need vs. supply ratio.

 

[Stagg737]

This is great. The less doctors that can push speed the better. This may be the best thing that will help psychiatry gain ground with the need vs. supply ratio.

Idk, I'd prefer a massive benzo shortage over stimulant shortage, but I don't think they'll ever be villainized or targeted to the extent of stimulants.

 

[Candidate2017]

No, Adderall shortage hasn't affected me. My focus is still scattered.

 

[Fluidity of Movement]

Wow, what a great thread! I'm glad to have been able to spark some good conversation.

I'm not asking for medical advice but psychiatry is one of my big interests and I have a lot of friends with ADHD so I am trying to stay at least somewhat informed (not that I'm trying to give them advice).

I haven't heard of Focalin, Adzenys, or Asztarys, these are new stimulant medicatons? I'm assuming no generics yet, but people can get them with insurance or through manufacturer programs?

 

[clausewitz2]

Wow, what a great thread! I'm glad to have been able to spark some good conversation.

I'm not asking for medical advice but psychiatry is one of my big interests and I have a lot of friends with ADHD so I am trying to stay at least somewhat informed (not that I'm trying to give them advice).

I haven't heard of Focalin, Adzenys, or Asztarys, these are new stimulant medicatons? I'm assuming no generics yet, but people can get them with insurance or through manufacturer programs?

Focalin was approved in 2001, so...not new if you trained after the 90s.

 

[Stagg737]

Wow, what a great thread! I'm glad to have been able to spark some good conversation.

I'm not asking for medical advice but psychiatry is one of my big interests and I have a lot of friends with ADHD so I am trying to stay at least somewhat informed (not that I'm trying to give them advice).

I haven't heard of Focalin, Adzenys, or Asztarys, these are new stimulant medicatons? I'm assuming no generics yet, but people can get them with insurance or through manufacturer programs?

Focalin has been around 15-20 years and was just a brand version of dexmethylphenidate. Adzenys has been around for 6 or 7 years, but Azstarys came out about 2 years ago, both are amphetamine formulations.

As of now, it's much easier to start patients on bupropion or atomoxetine from a resource standpoint than a stimulant and bupropion should be affordable to most through insurance or GoodRx. Atomoxetine may be more difficult as insurance doesn't always cover it or still may have high co-pays.

 

[calvnandhobbs68]

Focalin has been around 15-20 years and was just a brand version of dexmethylphenidate. Adzenys has been around for 6 or 7 years, but Azstarys came out about 2 years ago, both are amphetamine formulations.

Azstarys is dexmethylphenidate/serdexmethylphenidate. It's like the Vyvanse of Focalin.

 

[allantois]

I’ve had great success with Wellbutrin. One of the best drugs we have in Psychiatry

 

[clozareal]

Azstarys is dexmethylphenidate/serdexmethylphenidate. It's like the Vyvanse of Focalin.

Serdexmethylphenidate is the first schedule IV stimulant medication, although you can't get it without the dexmethylphenidate which is schedule II.

 

[Stagg737]

Azstarys is dexmethylphenidate/serdexmethylphenidate. It's like the Vyvanse of Focalin.

Yes, I think I was mixing up Azstarys and Mydayis, which really aren't all that similar, but both on my list of ADHD meds I don't prescribe because insurance makes it too painful to actually prescribe them.

 

[allantois]

Mydayis is on preferred list for some insurances surprisingly. Good alternative for patients who take Adderall XR bid since it lasts 16 hours.. I do have some who self-pay and since all new ones are roughly the same price, this is a potential option for some. Way too many stimulant options out there if you ask me..

 

[clozareal]

I've had no problem with some patients getting Mydayis without having to do a prior authorization.

 

[Fluidity of Movement]

I've been out of the ADHD scene for probably 7-8 years and have recently come back since I'm starting school again. It's been really great seeing all of the stuff on YouTube TikTok although I know a good bit of it isn't exactly accurate. Still, just the general support and awareness of things has been really cool. But then a lot of folks are saying ADHD is way over-diagnosed.

I'm just interested to see how things go in psychiatry from here, but hopefully the patients will be ok regardless of xyz.

 

[littlefred]

ADHD scene

lol