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Pharmacies field calls from 'anxious' patients as ADHD med shortages persist

Pharmacy teams have reacted with dismay as an attention deficit hyperactivity disorder (ADHD) charity has revealed that supply issues for ADHD drugs will continue well into 2024.

Supply issues for ADHD medication from manufacturer Takeda are expected to continue until April 2024, ADHD UK announced last week (November 28). 

According to the charity, which advocates on behalf of people with the condition, medication to manage ADHD has been “out of stock for many” patients since September. 

Read more: DH and MHRA ban wholesalers from hoarding or exporting five ADHD drugs

Takeda, which ADHD UK said is the “main” manufacturer of treatments for the condition, produces Vyvanse, which contains lisdexamfetamine dimesylate. The manufacturer has said that ensuring supply continuity of the drugs is its "biggest priority".

In September, the government issued a patient safety alert warning of “supply disruptions” to a number of medications of various strengths.

The affected ADHD medications were not subject to serious shortage protocols as of December 4.

 

“Suicidal thoughts” up 62%

 

The charity revealed the results of a survey of 1,054 people living with ADHD conducted last month, which showed that 97% of respondents had been “impacted” by the supply issue. 

According to the survey, 92% of respondents had experienced interrupted supply of medication, with 27% of respondents having received no medication since supply issues began.

Read more: Manufacturing issues behind ‘safety critical’ ADHD drug shortage, DH warns

Worryingly, the survey suggested that respondents experiencing “new suicidal thoughts or increased suicidal thoughts” increased by 62%.

According to the charity, people with ADHD have a “much higher” suicide rate than the general population.

 

“Tremendously difficult”

 

Hitesh Patel, chief executive of Pharmacy London – which represents the majority of contractors in the capital – told C+D last week (December 1) that “every pharmacy is struggling to obtain ADHD medication”.

"Matters are further complicated because almost all ADHD medications are controlled drugs so [it’s] impossible for pharmacists to swap brands or double up on strengths,” he said.

Every prescription has to be sent back to the GP to be amended, “by which time the requested drug may go out of stock”, Mr Patel added.

Read more: What can community pharmacists do to help their patients with ADHD?

And he stressed that pharmacies “are not in a position to keep [the drugs] in stock” because they are “very expensive” and patients have “frequent dose changes”, so pharmacies could end up with “dead stock” if they don’t have another patient for that drug and strength.

“How much time can you spend on one script?”, he asked, adding that there may be “a dozen other items on short supply” in the same day.

“It is tremendously difficult for community pharmacies and patients at the moment,” Mr Patel said.

 

“Upset and anxious” patients

 

Last week (November 28), pharmacy dispenser Hardeep Kallah commented on X, formerly known as Twitter, that he had spent “ages” on the phone trying to source medication for patients who he described as “upset and anxious”.

He said that the delayed resumption of supply would “make things worse”.

“It’s a never-ending circle trying to source medication for patients,” Mr Kallah added.

He told C+D on Friday (December 1) that the impact “has been disastrous” with worried patients calling about when they will get their medication.

Sometimes it is “impossible to get stock”, he said.

Read more: The problem unveiled: Reporting medicine shortages

Community pharmacist Rachael Patel also commented on X that she had a patient “in tears…begging” for their ADHD medication.

But she added that since she couldn’t source the medication “there is nothing we can do for them”.

And Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), raised the issue of ADHD medication shortages during her appearance at the pharmacy inquiry on November 21.

Dr Hannbeck told MPs that pharmacists could “see firsthand the stress” that shortages of medications like ADHD had on patients.

She called for a review of “the whole system” for medicine supply and for “better communications with everyone across the medicine supply chain”.

 

Takeda: “Intermittent disruption”

 

A spokesperson for Takeda told C+D on Friday that the “significant increase in demand” for ADHD treatments over the past two years has had an “ongoing impact on supply across the industry”.

They said that “limited” stock of different dose strengths across Takeda’s ADHD products are “becoming available at various times” in the UK, but that they anticipate that “there may be intermittent disruption until April”.

They stressed that this “does not mean that no stock is available until April 2024, but that supply will be available on an intermittent basis”. 

Read more: Suspended sentence for illegal POM dealers found with 1.3m pills

“We really are acutely aware of the impact that these supply disruptions are having on patients and healthcare professionals and ensuring supply continuity for patients is our biggest priority,” the spokesperson said.

They added that the manufacturer “continues to fully notify the Department of Health and Social Care (DH) of all stock shortages…in accordance with regulatory requirements".

 

DH “working intensively with suppliers”

 

A Department of Health and Social Care (DH) spokesperson told C+D today (December 4) that it is “working intensively with suppliers” to improve supply and acknowledged that the shortages were “frustrating and distressing”.

The spokesperson said that ADHD shortages were “primarily” caused by manufacturing “capacity constraints” and added that some of the supply issues had been resolved.

Read more: Antidepressant items rocket to 85.5m in 2022/23, new data shows

They added that the DH had issued patient management advice for NHS healthcare professionals and advised patients to speak to their clinicians about “the suitability of treatment with alternative medicines”.

The government has identified that the following ADHD treatments are currently suffering supply disruption: methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, guanfacine prolonged-release tablets and atomoxetine capsules.

The DH told C+D that eight strengths of atomoxetine, three strengths of Elvanse and two strengths of Equasym have been resupplied since October.

 

History of shortages

 

In October, the DH added five ADHD medications to the list of drugs that wholesalers are prevented from exporting or hoarding: methylphenidate hydrochloride, atomoxetine, lisdexamfetamine mesylate, dexamfetamine sulfate, and guanfacine.

The news came after the DH issued a patient safety alert in September, which warned pharmacies of “safety critical” shortages of a plethora of ADHD drugs. 

Read more: MHRA approves melatonin solution for children and adolescents with ADHD

The DH said that the shortages were caused by “a combination of manufacturing issues and an increased global demand” and said that the shortages were “expected to resolve at various dates between October and December 2023”.

It added that while other ADHD medications “remain available”, they “cannot meet excessive increases in demand”. 

When life is difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123, email them at [email protected], or visit www.samaritans.org to find your nearest branch.

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