The health crisis no one is talking about

“How do you get someone with ADHD to clean their house? Give them homework.

“What does ADHD mean? Attention deficit HEY DOUGHNUTS!”

“Why didn’t ADHD cross the road? He does not know. He intended to cross the road, and suddenly the day ended.

For millions of Americans who suffer from Attention Deficit Hyperactivity Disorder (ADHD), these jokes will get a wry smile, but they also reflect a painful reality about battling ADHD – a reality compounded by a shortage of Adderall for almost nine months. the land that seems to have no end in sight.

According to Matt Ford, a staff writer at The New Republic whose tweets Last month the Adderall Drug Tracking Challenge went viral, it’s really hard to explain ADHD to people who don’t have it. “It makes it harder,” Ford said. “It sounds simple. But, it is more difficult for me to remember to do things to process things and to complete tasks. And things pass. Faced with the prospect of not filling his prescription for Adderall, a drug he’s been taking since he was a child, he worried, “Could I remember to do chores? Could I remember to do simple tasks, like pay bills, respond to emails and texts” or even “do my job”?

These are not hypothetical concerns. Like Ford, I took Adderall and other stimulants after being diagnosed as an adult. Last December and January, when I saw the number of pills dwindle and it became difficult to fill a prescription for Adderall or its generic equivalent, the impact was profound and debilitating. (The fact that so many ADHD sufferers have had to take on the daunting task of calling pharmacies and finding out who had Adderall in stock, then contacting doctors to make sure new scripts are written is perhaps the cruelest joke of national scarcity. We are, without a doubt, the least equipped people for such work.)

Ask anyone with ADHD, and they’ll tell you that even on a good day, filling out and following through on a to-do list can be a daunting task. Indeed, the more tasks there are to accomplish, the more overwhelming it seems and the harder it can be to get started. And ironically, the attention required to do one thing can be so exhausting that it’s harder to move on to the next chore. Adderall or other ADHD medications have a chemical reaction in the brain that allows users to focus and concentrate in ways that would be impossible without it.

As Dr. Richard Friedman, Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at Weill Cornell Medical Center, told me: “When you suddenly stop the stimulants, you not only lose the effect of the drug, you have the withdrawal. You have a withdrawal syndrome, which is even more debilitating… Your brain has been flooded with a drug that increases dopamine and now it’s not.

Concretely, the times when I was without medication last winter left me wandering around my apartment, looking for anything that could distract me from having to concentrate, which will seem easy for the non-sick, but for those of us who have it, is a deep struggle. But I didn’t just feel inattentive, I was literally exhausted the whole time.

ADHD is traditionally associated with children and approximately six million children suffer from it. For children whose parents couldn’t get prescriptions for Adderall filled, it led to trouble sleeping, concentrating in school, keeping up with schoolwork, and other behavioral issues that could lead to interventions and even suspensions.

Ask anyone with ADHD, and they’ll tell you that even on a good day, filling out and following through on a to-do list can be a daunting task.

However, since the mid-2010s, adults are more likely to be diagnosed and to receive stimulants, although millions are likely to be undiagnosed. According to a recent study, 4.1% of Americans with employer-sponsored health care plans take stimulants. This would represent more than six million Americans, although the true number is likely higher and by some estimates could be as high as 16 million). The number of Americans taking stimulants has increased by 30% over the past five years and has increased even more dramatically during the pandemic.

Yet even though patients have been reporting for months that they can’t get their prescriptions filled, the issue has received limited media attention and even less regulatory or policy attention. Things got so dire, Friedman said, that he began to seriously explore the idea of ​​importing drugs from Canada to help his patients.

Paradoxically, one of the problems in solving the problem is finding a single explanation for why this shortfall occurs.

Part of the problem is certainly the aforementioned increase in prescriptions. During the pandemic, the rules were changed to allow prescriptions to be filled after a telehealth session (previously, in-person appointments were limited). As a result, by one estimate, almost 40% of all stimulant prescriptions now come from online visits.

Another hurdle is what the FDA called last October “intermittent manufacturing delays,” which have been exacerbated by supply chain issues that have plagued the global economy for more than two years.

The problem is compounded by the fact that Adderall and other ADHD stimulants are Schedule II controlled substances, meaning they have “a high potential for abuse” and are therefore strictly regulated. As a result, the Drug Enforcement Administration, rather than the Food and Drug Administration, decides how much of the drug is produced each year and how much each pharmacy can buy. The DEA refused to increase these quotas in January.

Rep. Abigail Spanberger (D-VA), who is one of the few members of Congress concerned about the Adderall shortage, rocked the DEA and FDA with questions about the Adderall shortage. Yet she still hasn’t received “a full explanation of why this is happening,” she told me in an interview last month. According to Spanberger, we still don’t know how [the shortage] ends or when it ends.

But the biggest problem, from his point of view, is that “no one was ringing the bell that we were about to have a shortage”. With the lack of media and political attention to the issue, the problem has steadily escalated and ADHD sufferers have been left behind, left to fend for themselves or find a solution on their own.

As Spanberger sadly noted, “Part of the problem is that people don’t see these drugs as essential”, and because there can be abuse of Adderall, it creates a stigma around the drug and means that “people don’t watch it”. in the same way” as they would for any other disease. During our conversation, she hinted that one of the challenges in getting her House colleagues to join her in addressing the issue is the stigma around ADHD, and members don’t want to be seen stand up for an issue that can so easily be stereotyped and dismissed. .

As Friedman pointed out to me, “It has long been suspected that ADHD has been significantly overdiagnosed.” Certainly, the image of students taking Adderall to prep for a test or complete an essay has become prominent in popular culture. A telehealth company, Cerebral, which is currently under federal investigation, ran an ad campaign that linked ADHD to obesity and associated vague symptoms with the disease. Unsurprisingly, the company wrote prescriptions for 97% of users, and sometimes after online consultations as short as 30 minutes.

These stories, says Friedman, have “fueled a public perception that [ADHD] is either a benign problem, or a made-up problem, or even worse, those diagnosed are just lazy. For people with ADHD, these attitudes are frustrating to hear but perhaps understandable. It’s hard to explain to people who don’t have ADHD why the condition makes seemingly ordinary, everyday tasks so difficult or how just popping a pill can make the difference between a productive day and one that isn’t. not. People who take stimulants aren’t lazy, but without them that’s what they become.

Another popular myth about ADHD and prescription stimulants is that those of us who take these drugs are addicted to them. But as Fridman pointed out, this is “a common misunderstanding. Addiction means taking increasing amounts of a drug to get high. But when you take stimulants, “you’re not tolerant of them. You don’t need more. People don’t take Adderall to feel euphoric, but rather to function.

This is one of the ongoing frustrations of covering the Adderall shortage. ADHD isn’t well understood or appreciated, but as Ford told me, for those of us who use it, it’s “life changing.” My quality of life would be significantly worse,” he added, and “I wouldn’t have the career I have” without Adderall.

He joked that it was important to fight ignorance about ADHD, but “everyone who complains [it] I can’t concentrate enough to raise the hell. As long as there are stigmas and misunderstandings about mental health, those with ADHD will struggle to help others understand why this condition can be so debilitating and how a simple pill can make such a difference. After all, how do you explain why tasks that seem so easy for others can be so difficult for us?

And it is perhaps also the best explanation why nine months after the start of a national shortage that has affected the lives of millions of people, there is still apparently no end in sight and such urgency to remediate.

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