Aderall Or Nothing: Anatomy of the Great Amphetamine Drought

pigrabbitbear writes "To prevent hoarding of materials and their potential for theft and illicit use, the Drug Enforcement Agency sets quotas for the chemical precursors to drugs like Adderall. The DEA projects the need for amphetamine salts, then produces and distributes the materials to pharmaceutical companies so that they can produce their drugs. But with the number of prescriptions for Adderall jumping 13 percent in the past year, pharmaceutical companies claim that the quotas are no longer sufficient for supplying Americans with their Adderall. The DEA contends that their quotas do, in fact, meet demands, and that any shortages arise from pharmaceutical companies selectively producing only certain, typically name-brand and more expensive versions of ADHD medications."

Comments

Pain

[Verdatum]

This has been a huge pain for me personally. I've been on adderall for over a decade and have only had problems finding in stock in the last 8 months or so. Most recently, I had to get my doctor to write an additional prescription for a higher dose and split the pills in half since this was the only strength anyone in my area had in stock. So in trying to keep supplies low, I've now got permission from my doctor to get twice as much amphetamine as before. Where is the sense in this? Having to pick the prescription up in person, since it's a CII substance added extra pain.

FWIW, I was a pharmacy tech while working through HS and college, and the entire time, we never had such bad problems with backorders on any product (with the possible exception of when albuterol inhalers were required to switch to CFA free, another massive screwup).

Re:You know...

[Verdatum]

The DEA does do a lot of important things. As a pharmacy tech, we often worked with the DEA to put a stop to both customers passing phoney prescriptions, and doctors giving massive prescriptions for controlled substances to anyone. However, forcing low stock doesn't help any of this. CII substances are kept under active inventory. Every supplier and every pharmacy must know--to the exact pill--how much stock they have. All CII prescriptions are double counted. If some stupid pharmacy tech starts swiping pills, it gets noticed, quickly. The only benefit for keeping stock low is financial. Since comparatively, generic adderall isn't even very expensive, I can see no reason why it, among so many other things should be the scape goat for this.

Re:Considering how often Adderall is abused...

[ZeroSumHappiness]

In general, they were labeled "troublemakers", "bullies", "class clowns" or any other of a number of meaningless epithets that did nothing to help them get ahead and allowed them to just play their role in society before becoming some blue-collar laborer or small time criminal.

Yes, everyone you've met on Adderall (that you know of...) are addicted to it. Everyone I've met on Adderall can fly like Superman. What does anecdotal evidence (especially that which is uncited) have to do with it again?

Re:Hmmm, lets sell 2,000 guns to criminals

[i.r.id10t]

The DEA had nothing to do with Fast-n-Furious - that was the BATFE (which should be a convienence store not a government agency)

Re:You know...

[garrettg84]

Please step down from your pedestal. We already have the FDA. We don't need the FDA *AND* the DEA regulating our drug use. We already have the FBI (if you want something federal) and the state police (if you want something state), and/or local police (if you want something county/city/unincorporated) to do the actual enforcement.
But what about stopping drugs before they enter our country?
We have boarder patrol, coast guard, and relationships with foreign governments.
get off my lawn?

Re:Considering how often Adderall is abused...

[Hecubas]

Your personal anecdotes may be well founded. However, I have a personal anecdote too. I have a child who is on Addreall and I can attest to how much better it makes him function. Since the last 2 years of taking it, he has made leaps and bounds in his ability to speak and articulate thoughts. Without the drug, he reverts to extremely erratic behavior, his speech suffers, and sometimes he unintentionally hurts himself. Recently, the Adderall shortage caught us off guard once, and we had a fairly wild weekend with him (not the only time actually). So yes, he is a clear case of where the drug works as intended.

That people abuse this drug upsets me to no end. I'm reminded of it every time I have to go through the prescription refill process.

For the record, I'm not one of the parents that would dose up their kid just to get him to sit still and be quiet. Far from it. I'm certain without it, he'd be held back or in a special needs school.

Re:Considering how often Adderall is abused...

[crakbone]

Here is the link for you. http://www.washingtontimes.com/news/2012/feb/13/feds-shut-down-amish-farm-selling-fresh-milk/

Re:Ah, central planning.

[pixelpusher220]

Uh, the war on drugs is from Reagan. This was instituted to prevent illegal use of the drugs.

Quick googling provides quota history back to at least 2002 so maybe it was Bush.

Personally I'd love to see Limbaugh come out against the quotas on Oxycontin...

Re:Considering how often Adderall is abused...

[roc97007]

What did people do before Adderall then, simply not function? It's only been around for around 30 years.

My child is not ADHD, but was diagnosed as such by the school system (long story) and as a result I did quite a bit of research and talked to parents of kids and to adults who had the affliction.

Without drugs there are coping skills but how they work depends on how bad your case is. For instance, a co-worker who has a mild case, has a hard time communicating because he jumps around on topics and gets buried in sub-clauses. His coping skill is to put a finger down on the desk each time he shifts topics to remind himself to go back and complete the original topic.

As to how severe cases dealt with it without drugs, they'd often have a hard time getting good grades or staying employed despite high intelligence, feel ostracized and unappreciated, diagnosed as "discipline problems" and find themselves clients of the justice system. For those who really need the drugs, they really need the drugs.

There are a few careers (art, music, broadcasting) where ADHD isn't a deficit and may actually be an advantage. But it's not a safe bet.

If you need an example that may be easier to understand, for people who really need antidepressants (which are somewhat overprescribed also, in my opinion) really NEED them, because without the drugs, clinically depressed people really can not function. (Even *with* the drugs they may never be normal, but may at least be able to hold down a job.)

Re:Ah, central planning.

[therealkevinkretz]

The War on Drugs (and the creation of te vile-named office of Drug Czar) is from *Nixon*. Along with it came the justification for "no-knock warrants", which itself has led to the 3AM ninja-suited, automatic-weapon toting bashing-down of doors for seemingly decreasingly dangerous arresting or warrant serving.

Re:Ah, central planning.

[hldn]

act of god is a legal term, irrespective of one's belief in a deity.

Re:Ah, central planning.

[HexaByte]

The ADHD 'explosion" is a function of govt.

Kids with ADHD can get a Social Security check. Also, Schools may not have to perform up to standards if they have too many kids with ADHD, so they push parents into getting their kids diagnosed with ADHD, which too many doctors are happy to do, since the govt. will pay for their treatment.

So, in effect, it a central planning thing that caused the problem that the other central planning thing is causing a problem for.

Why do I think the pharmaceutical companies' complaints about not getting enough amphetamine ingredients to allow them to make "enough Adderall" doesn't really have anything to do with Adderall at all?

And how much fucking Adderall do we really need? All of a sudden, the US can't function without sufficient supplies of Adderall. That all those second graders who don't give a fuck about school will be fine if their parents just fork over the $1200 bucks a year for their bottles of meth.

So if some hillbillies want to make speed, the chemicals are bad, m'kay? But when Big Pharma wants to make sure that every other second grader is lit up with enough methamphetamine to give a horse a heart attack, that's good. Because they are the "job creators". And all those yuppie parents who spend less than an hour a day with their kids believe that they're being great parents because they're making sure to fill those prescriptions so they don't have to actually be parents. Well, to be more truthful, they can't really afford to be parents because mom and dad are both working 60 hour weeks in order to have a lower middle-class lifestyle that would have only taken one parent working 40 hours just 35 years ago. Isn't a better treatment for ADHD just having actual parents who are home and not so exhausted that they are unable to be effective parents? Why is ADHD so much more prevalent in "free market" societies where health care costs are artificially inflated by the "free market" than in more "socialist" countries like Canada, Sweden, Iceland?

And this asshole thinks that the problem is "central planning" and not a pharmaceutical industry that gets rich by selling meth to second graders. Wonderful.

Can someone tell me why every other second grader has "ADHD" all of a sudden anyway? Was there some catastrophic event at the turn of the millennium that caused some gene mutation that has expressed itself in a psychiatric disease that is now the most widespread pediatric disorder in the nation, affecting more children than the next three childhood illnesses combined? Or is "ADHD" a marketing opportunity?

Here are the signs and "symptoms" of ADHD (from Wikipedia). Check this shit out:

Predominantly inattentive type symptoms may include:[29]

Be easily distracted, miss details, forget things, and frequently switch from one activity to another Have difficulty maintaining focus on one task Become bored with a task after only a few minutes, unless doing something enjoyable Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities Not seem to listen when spoken to Daydream, become easily confused, and move slowly Have difficulty processing information as quickly and accurately as others Struggle to follow instructions.

Predominantly hyperactive-impulsive type symptoms may include:[29]

Fidget and squirm in their seats Talk nonstop Dash around, touching or playing with anything and everything in sight Have trouble sitting still during dinner, school, and story time Be constantly in motion Have difficulty doing quiet tasks or activities.

and also these manifestations primarily of impulsivity:[29]

Re:Ah, central planning.

[PopeRatzo]

I think Adderall is just straight amphetamine, not methamphetamine. No extra methyl group there.

Oh, I see it's a combination of dextroamphetamine and amphetamine. Well then, never mind. It's perfectly safe and healthy for children.

Every child ought to gobble them and wash them down with a Super Mega Gulp of Coca-Cola.

Re:Legalize and Tax

[nbritton]

IMHO the drug rehab system is a joke in this country. I once knew a teenager who was addicted to heroin, he wanted to stop so he went to his parents for help. They took him to two different hospitals and both refused to help him, stating that "we don't treat that here". Next they went the local methadone clinic and even they refused to help him, stating that they only treat people who have been addicted for more than three years. Finally they determined the only way to get the necessary help was to have judge order the hospital to admit him through involuntary commitment proceedings. Even then, the hospital kicked him out after a couple of days. They did arranged treatment at a rehab center, but apparently this was the only approved center in the state so the waiting list was over a month to get in. In the mean time he had a prior felony (with deferred judgement / probation) drug charge and was now thrust back onto the streets with the same group of people while still having intense cravings. They wanted him to go live with his grandmother, but of course since he was on probation he couldn't leave the area. The consequence if he was arrested again would be guaranteed prison time and a felony permanently on his record. I think what they did was bordering on criminal, he just wanted help.

You'd think, but...

[doug141]

The current methotrexate (chemo drug for children) shortage is due to suppliers opting to make more expensive drugs on their manufacturing equipment. For some reason, the free market isn't working to keep supplying methotrexate, or numerous other generics. Just google "drug shortage" for over 100 examples.

Re:You'd think, but...

[nbauman]

The supply of methotrexate isn't exactly limited by the government.

As I recall, there were 2 companies with the capacity to make methotrexate in the U.S., but they both had problems meeting the good manufacturing standards for pharmaceutical drugs. Injected methotrexate can be fatal if it's not manufactured properly. Yes, they weren't meeting federal standards, but no pharmaceutical manufacturer in his right mind would manufacture these drugs without meeting the same standard.

I know a bit about the chemical processing industry, and according to the textbooks, when you have 2 manufacturers producing an unreliable supply of a specialty chemical with inelastic demand, and shortages develop, a third company is supposed to move in to the market and produce that chemical at a price which is slightly higher than the old, unsustainable price but less than the monopoly price of a patented chemical.

Not only are there U.S. manufacturers capable of manufacturing methotrexate, but there are also capable foreign manufacturers in Europe, India, China, Israel, etc. who are regularly FDA-inspected and approved for other drugs, and even do contract manufacturing for major brands here.

I don't understand why the free market isn't working, and why additional manufacturers aren't jumping into the market for drugs like methotrexate.

Re:You'd think, but...

[nbauman]

Yes, there was a good series about that in the New York Times a few years ago.

The Chinese are very capable manufacturers, not only of drugs but also feedstocks to make drugs. Some American and European manufacturers established their own quality control procedures, and they did OK. But most of the American manufacturers put their suppliers under heavy price competition, which lead to a race to the bottom, and there have been a lot of Chinese products (like heparin) that, through carelessness, negligence or outright fraud, were improperly manufactured and caused widespread illnesses and some deaths. The FDA didn't have the resources to inspect Chinese plants, so we've got global competition without the oversight. The Times had difficulty locating manufacturers even when they knew the names. There's a long international distribution chain, and it's usually impossible to trace a Chinese drug back to the source. The Chinese government didn't care, had almost no oversight, and dealt with a few of the worst scandals (in which Chinese were harmed) by executing the suppliers. I think it shows what would happen if the libertarians had their wish of eliminating government regulation and letting the free market take care of it, as we did before 1916. As I understand it, Communism in China meant that drug companies and hospitals were run by the Red Army, which is politically powerful enough to do whatever they want without much oversight. Between the cracks they have wealthy businessmen running drug companies (I assume they have connections with the Red Army). It's like Halliburton and Blackwater under the Bush Administration.

India has a much older pharmaceutical industry, with chemists like Cipla, who have had several generations of European-trained owners running the plant. They go to European and American conferences. They do contract work for American and European companies, so they're FDA-inspected. They supply generics to the third world, so they can do it cheaply. For a long time, Indian law allowed them to manufacture generic copies of drugs that were still under patent in America and Europe, if they could "invent around" the patents, so they were under a lot of pressure to be good chemists. Otherwise, poor Indians would have just died. The Indians seem to understand the whole system, whereas the Chinese are just contract manufacturers.

It's not because the Chinese are stupid. There are some pretty smart Chinese scientists, many of them trained in the U.S. It's because of the system and the accountability. I'm sure the Chinese will be major players in the pharmaceutical industry in the next few decades. If you gave them a well-defined drug manufacturing task to do, and established good quality control, they can do it. I'm looking forward to seeing what Chinese scientists will contribute to molecular medicine in the years ahead.

But I don't understand why the Indian and Chinese manufacturers can't produce methotrexate to FDA standards.

Re:Ah, central planning.

[Anonymous Coward]

http://en.wikipedia.org/wiki/Kathryn_Johnston_shooting. To elaborate.

Re:Ah, central planning.

[Strider-]

So let me get this straight. What you're saying is that ADHD is an over diagnosed disease that you personally have been diagnosed with... and what's more, you have found that with the intake of prescribed amphetamine, your attention span increases?

That's exactly the way it works. For those of us who have AD(H)D, the stimulants in correct dosage have the opposite effect as to what you would expect. For me personally, my productivity goes through the floor if I am off my meds. I pretty much lose any sense of organization and prioritization, and wind up working on whatever I see as shiniest in that instant. The whole "I suffer from Attention Defici... hey wanna go ride bikes?" is truer than you'd think.

I myself am on Concerta, which is an ultra-slow release version of Ritalin (Adderal did weird nasty shit to my personality and sleep patterns) which works a treat. It really does feel like a good, strong cup of coffee in the morning and not much else. I can actually partially self medicate by using significant quantities of coffee, but then my sleep patterns are really destroyed.