The supply problem is not limited to ADHD medications. I do not know all of the factors behind this, but I think there needs to be more domestic production of all medications in a manner that is financially viable for the manufacturers.

Firstly, we have to make sure that we are screening and diagnosing patients appropriately for ADHD. Lots of medical conditions can mask or occur concurrently with ADHD. Sadly, lots of people also know what to say or how to act in order to falsely have the diagnosis thereby getting access to medications that they may abuse, sell or divert. Another step would be to enforce a contract with the patient, and to always use the prescription drug monitoring database prior to writing the prescription.

Check that supply shortage isn’t artificially created

I've known for some time now that Adderall and similar adhd meds are being abused by college students. I did a google search and the estimate is up to 20% of college students are doing this. There has got to be a better answer than RX'ing stimulants to children(or adults) that end up being diverted for abuse. It is seriously time to clean this mess

I found that the shortages were primarily in the longer acting preparations, especially dosages of Adderall XR, so I was able to mitigate this in many cases using the shorter acting tablets and recommending these twice a day.

We need to ensure access to these medicines to allow for increased functionality.

There will always be a need for new and improved meds for ADHD

Need more efficient manufacturing and no shortage in my area but insurance can be tricky some times.

stop reflexive prescribing of stimulants as initial line of therapy
create some type of impetus for prescribers to initiate alternative therapeutic regimens from initial time of diagnosis

Less néw prescriptions- more alternative therapies rather than reflexively starting stimulants

There is no question that ADHD is an over diagnosed condition and the overwhelming diagnosis are based on the questionaire filled out by the patient/parent and almost they come to the office with the pre determined mind set to have the prescription for the stimulant and that has driven the increased prescriptions for Stimualnts and invariably they do get the prescription ! COVID has defintely fueled this diagnosis and hence prescription writing and seems to be main factor leading to the supply shortage ! Another aspect is the role of the mid level providers in certain states where they are allowed to write the controlled subsantce have a very low threshold to write the script as above ! ADHD is a serious diagnosis with profound ramifications for the rest of the life for any one and due diligence needs to done in making a diagnosis rather than just a very subjective based intent to have a stimulant medication ! There are lot of options like Strattera /therapy that can be used and more intrusive inquiry and eval can be done for anxiety disorder before comitting to writing for the Stimulant medications ! these steps can help in revaluating this situation and hopfeully help deal with the supply shortage !

Open coverage for alternative medications.
Pursue non-stimulant options, both counselling and non-stimulant meds.

I believe the supply side deficient is due to too much government regulatory oversight into how much of this drug can be manufactured. There is also a quality issue, the pharmaceutic companies are focused on production of quality products; the law of supply demand economics applies to this issue we are seeing now.

I think that supply chain issues need to be addressed at both the prescriber and manufacturer levels. In regards to prescribers, there has to be clear guidance as to when and when NOT to prescribe these medications to their patients, and at the manufacturer level, there has to be good insight and knowledge as to how best to distribute and deliver these medications to pharmacies, hospitals, doctor's offices, and end-users (patients) in a safe, efficient, and cost-effective manner.

It is a responsibility of us as physicians to only prescribe it to patients who have had proper testing o confirm diagnosis. Also pharmaceutical companies and the Govt need to step up to help with the supply.

I agree with Michael Katz that "...when there are shortages, insurance companies should approve branded stimulants without prior approval until adequate amounts of generic medication are again available." Insurance coverage is a major barrier to getting our patients the appropriate medications overall, and it only gets worse when there is a manufacturing shortage.

My practice has been experiencing shortages for the past year and the reasons are complicated by the increase in demand with the lack of production. The FDA does limit the amount that is available, and unfortunately this leads to random shortages that impacts certain areas/patients greater than others. There is no simple solution, but I have switched agents and even promote non-stimulants as alternative treatments.

Mental health is a significant portion of my IM practice. Thought leaders in ADD are moving towards more ER medications as there is less diversion potential. Not treating ADD leads to more impulsive behavior, crime, divorce, etc. Treatment is needed.

The supply has been consistent so far in my area with little supply difficulties but access through insurance has been spotty at times.

It is important to not over diagnose ADHD, which is probably easier to do over telemedicine than in person. The amount of amphetamine produced yearly is controlled by the DEA, which is not exceptionally too low at this point.

I think this boils down to supply chain issues and US companies largely shipping manufacturing overseas. Sure, the FDA could do a better job fast-tracking medications, but if the raw materials still have to come from China we are in trouble. There doesn’t seem to be any problem getting fentanyl in the USA! We need more manufacturing here in the USA away from places prone to hurricanes like Puerto Rico. Amazon now has a pharmacy service; perhaps now they need to start manufacturing these medications so our patients can get their needed meds without all the usual issues with prior authorizations. Take the insurance companies out of the equation!

Availablity of medication is a responsibility of pharmaceutical companies-they need to manage the demand for the drug by increasing production as needed.
i dont think covid pandemic had anything to do with this.
FDA needs to work with pharmaceutical companies.
On the other end -then medication use in children has to be monitored by parents to prevent misuse-also be proactive in getting medication refill on time to prevent disruption in use and ensure compliance
This has to be handled at multiple levels.
Fast approval of generic options will help too.

It's really unfortunate that the epidemic of ADHD is so prevalent, either because of actual pathology or because of overdiagnosis and overmedication that there's a shortage. The supply chain for lots of essentials has been backed up but medication seems the most egregious. One option is to have stricter diagnosis/medication criteria so kids who really need it have access. Another may be to vary the medications and use older and newer meds such as Ritalin, Adderall, Vyvanse, etc so if one is out you can use another.

Agree difficult situation but great drug to help combat disease process

This all comes down to supply and demand mismatch. Just certain GLP-1 agonists, abrupt increased demand and stagnant supply resulting in the shortage. There has to be a rapid increased production as well as generics availability. The alternatives and other effective treatment options need to be supplemented as well.

Defintely FDA role will be big in improving access. We use in house pharmacy thats licensed in over 48 states and they have been to source it better than local pharmacies.

There was also a shortage about 15 years ago which did not last too long but it was only for generics. We work with a specialty pharmacy that does a great job of keeping most stimulants in stock and informing us of how we can get around anything they are out of- using two 10 mg adderall xr caps per day when 20 mg caps are out, etc.

It is definitely a daily problem that we see as psychiatrists. It is very frustrating to have to change a patient back and forth monthly between amphetamine and methylphenidate products depending on what is available that day.

I am not in favor of this idea but one option could be to limit the amount of stimulants that adult patients could obtain as a population each month. The children would have first access to the stimulants before the adults.

Need to have more manufacturing in this country, so supply issues are not tied to supply and policy disruption.

Manufacturing constitutes a major problem, however coupled with telehealth has led to a change in supply and demand. A lot of unregulated upstart online companies have fueled this. Unfortunately the ability of untrained mid-level prescribing has been problematic. FDA and other agencies hopefully will step in soon to mitigate further problems. Non stimulant of course are not an issue, which is interesting.

This is a major headache for parents and patients to get the medication they need. They often have to call multiple pharmacies to find it in stock. Fortunately, our in-house pharmacist has developed a robust list of alternative agents with comparable dosing strategies. It’s just a real nightmare all the way around. Hopefully there’s some resolution soon.

I do not totally accept the reasons cited for the lack of supply of stimulants as being due to the pandemic. The fact is that there were NEVER any supply or availability issues for the first 30 years I was in practice. The supply issues began appearing at least 5 years prior to the start of the pandemic. And every year since around 2015 there have been shortages long before COVID-19 appeared. These shortages usually began in mid-December and ended by mid February. But there have never been shortages that lasted an entire year like this year which I would remind you is the year the pandemic "ended". The FDA is indeed in charge of regulating the yearly release of the raw materials necessary to produce stimulants. The party line is that the FDA based their release of raw materials in 2023 on 2022 data. But that makes no sense as there were shortages last year, which means those in the FDA who were in charge so grossly underestimated how much was needed it bordered on total incompetence.
It is also notable that 3 months before Vyvanse went generic, Takeda pharmaceuticals the maker of Vyvanse reported there would be significant shortages of it. This seems to be a deliberate reduction in production anticipating the impending availability of the generics. Since many people were switched to Vyvanse when generic mixed amphetamine salts were so scarce this just exacerbated the shortages further.
I believe there are also other factors involved that we are not privy to.
That said, I do agree that when there are shortages, insurance companies should approve branded stimulants without prior approval until adequate amounts of generic medication are again available. This is not a novel proposal. When generic Concerta was released, initially there was only one company which was located in China producing it. It was poorly made and was causing horrible nausea to the point that patients couldn't tolerate it. The insurance companies allowed patients to get Brand Concerta until other more quality generics became available.
I would also add that in general my experience with non stimulants for ADHD are effective perhaps 20% of the time and less tolerable. Thus I don't think that's a viable option.

A greater emphasis should be placed on non stimulant based alternatives early in treatment with stimulant meds being used after their failure.
Also, during such a shortage drug companies should be more agreeable to approve use of brand name stimulants without the necessary failures prior to approval, as often times the failures required are all of medications that have the supply issue.
Lastly there should be judicious use of stimulant meds including not being allowed to go beyond the FDA recommended dosing despite efficacy beyond such dosing.

Some steps that can be taken to address this issue is to
encourage regulatory agencies to expedite the approval process for generic versions of ADHD medications to increase the supply and to increase telehealth options as mentioned in the Ryan Haight Act.

To mitigate the short supply and provide increased access to psychostimulants for children with ADHD, several steps can be taken. It's important to note that these steps should be carried out while adhering to medical guidelines and ethical considerations:

Manufacturing and Distribution Increase: Encourage pharmaceutical companies to ramp up production and ensure a consistent supply of psychostimulant medications. Government support or incentives might be necessary to encourage this, given the ethical considerations and strict regulations surrounding medication production.

Regulatory Measures: Streamline and expedite the approval processes for generic versions of ADHD medications. This can introduce more competition, potentially increasing supply and reducing costs.

Education and Awareness: Educate physicians, caregivers, and the public about alternative treatments and medications available for ADHD. This might include non-stimulant medications, behavioral therapies, or lifestyle adjustments.

Telemedicine and Remote Consultations: Implement telemedicine services for initial consultations and follow-ups. This can increase access, particularly for those in remote areas or with limited mobility.

Support for Research and Development: Encourage research into new medications and therapies for ADHD, aiming for more diverse and effective treatment options. Government grants and support might incentivize this.

Regulate Distribution and Prescribing Practices: While ensuring access, it's crucial to monitor and regulate the prescription and distribution of psychostimulants to avoid misuse or over-prescription.

Multi-disciplinary Approach: Promote a multi-disciplinary approach involving psychologists, counselors, and educators alongside medical professionals. Non-medication-based treatments could be explored further and utilized more effectively.

Support Groups and Community Initiatives: Encourage and support local community initiatives and support groups for families dealing with ADHD. These groups could provide information, emotional support, and advice on managing ADHD without solely relying on medication.

Insurance Coverage and Affordability: Advocate for insurance coverage and affordability of ADHD medications. This might involve negotiation with insurance companies and policymakers to ensure these medications are accessible and affordable.

Early Intervention and Screening: Implement programs in schools and healthcare facilities for early detection and intervention for ADHD. Early identification and treatment can reduce the severity of symptoms and, in some cases, reduce the need for long-term medication use.

Behavioral Therapy and Support Programs: Support and promote behavioral therapy and other non-pharmacological interventions that can be used as alternatives or in conjunction with medication to manage ADHD symptoms.

By adopting a multifaceted approach, involving various stakeholders such as pharmaceutical companies, healthcare professionals, policymakers, and communities, it's possible to address the shortage of psychostimulants for children with ADHD and provide increased access to necessary treatments. However, it's important to do so while considering the safety, efficacy, and ethical implications associated with these medications and treatments.