When the FDA first announced a shortage of Adderall in the United States in October, it expected it to happen. solve it quickly. But five months later, the effects of the shortage are still making life difficult for people with attention deficit hyperactivity disorder who depend on the drug. Stories abound of frustrated people going to dozens of pharmacies each month for medication. just lack every time.Without treatment, students i had a hard time at schoolthe adults have been struggling. keep working and maintain relationships. Although the Adderall shortage has been eliminated, there is still a shortage of the widely used generic version of the drug known as amphetamine mixed salts.
David Goodman, an ADHD expert and professor of psychiatry at the Johns Hopkins University School of Medicine, told me the shortage was caused by “perfect storm” factors such as manufacturing delays, labor shortages and tight regulations. . And the fact that the pandemic has caused a surge in American demand for Adderall makes it all worse. According to the recent CDC, the most dramatic changes occurred among adults. report From 2020 to 2021, some age groups increased by more than 10 percent in one year. This is the nature of the surge in demand for Adderall. adultThat’s why some ADHD professionals are concerned, “Is the claim justified?” Goodman said. At least some of these new Adderall patients may be receiving prescriptions they don’t need, he said.
The problem is that there are no standard clinical guidelines in the United States for how physicians should diagnose and treat ADHD in adults. CDC has that gap. called “Public Health Concerns.” When people come in for help with ADHD, providers “have many choices about what to use and when, and those parameters influence good or bad care,” says a psychiatry professor. said ADHD expert Craig Thurman. The scientific coordinator of adult ADHD research at Harvard University and Massachusetts General Hospital told me. Stimulant shortages will disappear, but adults with ADHD may still not get the care they need.
for over 200 years, ADHD-related symptoms such as difficulty concentrating, difficulty sitting still, and fidgeting are primarily associated with children and teens. Doctors widely believed that children would grow up and outgrow the condition. Although the symptoms “become evident very early in life,” one Scottish physician wrote in 1798: [is that] It generally decreases with age. ” For some people, ADHD symptoms actually improve as they get older, but for most people, symptoms persist. Due to parental pressure, the emphasis continues to be on children even today. Thurman says pediatricians need to build a child-focused model of ADHD because parents come in and say, “What are you going to do with my child?” As a result, treating her ADHD in children aged 4 to her 18 is relatively straightforward. clear clinical guidelines A paper from the American Academy of Pediatrics clearly states the need for a rigorous psychiatric examination that excludes other causes and includes patient reports from parents and teachers. Treatment usually includes behavioral management and, if necessary, medication.
However, unlike other developed countries such as the UK and Canada, the US does not have a comparable treatment for adults with ADHD. In fact, this disorder has only recently been recognized in the field of adult psychiatry. One reason this has been overlooked for so long is that ADHD can look different in children compared to adults. For example, physical hyperactivity tends to decrease with age, as opposed to emotional or organizational problems. “In the last two decades, there has been widespread recognition that ADHD is a lifelong disorder that lasts into adulthood for most people,” said Margaret Sibley, professor of psychiatry at the University of Washington School of Medicine. And the field of adult psychiatry is lagging behind. ADHD in adults is addressed directly for the first time. DSM-5—The Diagnostic Bible of the American Psychiatric Association— 2013but the standards described there have not yet been translated into practical instructions for clinicians.
Dealing with ADHD in adults is not as easy as adapting child standards to adults. An important difference is that the disorder negatively impacts many aspects of adult life. A pediatrician examines the effects of ADHD in school and home, while a health care provider evaluating an adult may examine her ADHD effects at work and in romantic relationships. Sources are also different. A parent or teacher can disclose the child’s situation, but “she cannot call the parent of a 40-year-old child to ask for an opinion as to whether the person has ADHD for her.” Let’s go,” said Mr. Sibley. Providers typically rely on self-reporting, which is not always accurate. Complicating matters, ADHD symptoms tend to be masked by other cognitive problems that arise in adulthood, such as those caused by depression, drug use, thyroid problems, hormonal changes, and more. is. “ADHD is a difficult disorder to diagnose. There are no objective tests.” The best option is a long-term psychiatric evaluation. This usually involves reviewing symptoms, performing a physical examination, taking the patient’s medical history, and evaluating the patient using rating scales or checklists. According to APA.
Without clinical guidelines and organizations enforcing them, there is no pressure to maintain that standard. For example, the virtual forms of his ADHD care that surged during the pandemic rarely led to long-term evaluation. Cerebral, the leading telemedicine platform that dispenses prescriptions for ADHD, investigated For sacrificing medical rigor for rapid treatment and customer satisfaction, people without ADHD may be able to obtain Adderall for recreational purposes. In one survey, 97 percent of brain users said they had received any kind of prescription.Initial talks with providers lasted briefly half an hourreport wall street journalex-employees feared that the company was rampant in prescribing methamphetamine. fuel an addiction crisis. “It’s impossible to do a comprehensive psychiatric evaluation in 30 minutes,” says Goodman. (Brain previously denied cheating and no longer prescribes Adderall or other stimulants.)
A bigger problem is that too few providers have the ability to make such assessments in the first place. Because ADHD in adults was only recently recognized, most psychiatrists working today have no formal training to treat this disorder. “There is a lack of expertise,” says Thurman. “At the moment, consumers are often educating themselves about their providers, creating a confusing situation.” of adults are seen by professionals such as primary care physicians, social workers and nurses, which means they lack the experience to provide it. “It’s a systemic problem. It’s not that they’re negligent,” Sibley said.
A shortage of trained health workers can lead to inadequate or dangerous care. Adderall is just one of many stimulants used to treat ADHD, but choosing the right stimulant for a patient can be difficult. Also, not everyone with ADHD needs or wants to take stimulants. However, even the most well-meaning medical professionals may not be prepared to properly assess a patient. The federal government considers Adderall, like oxycodone and fentanyl, a highly addictive Schedule II drug, and the risk of unnecessary prescribing is high. Besides addiction, it can also cause problems such as heart problems, mood changes, anxiety and depression. Some people with ADHD behavioral therapy or narcotics It’s not a stimulant. Unfortunately, it is very easy for inexperienced healthcare professionals to start and continue treatment with these drugs in their patients. “If you give a normal person meth, they’ll say they feel better, they think better, they have better energy,” says Goodman. “It’s very important not to make a diagnosis based on your response to stimulants.” But more and more adults are taking these drugs. since at least 2016 This is a sign that this may be happening.
The fact that adult ADHD is on the rise may soon bring about a change. Last year, the American Association of ADHD and Related Disorder Professionals started drawing A long-needed guideline. APSARD’s treasurer, Goodman, said the organization’s goal is to standardize adult ADHD care and treatment nationwide. He added that establishing standards could have “broad and pervasive implications” beyond patient care. The existence of the standard could force more medical schools to teach about adult ADHD, persuade insurance companies to cover treatment, and pressure lawmakers to include it in workplace policies.
A way out of this mess, however long-awaited, will be needed more and more.Almost 5 percent of adults are believed to have the disorder, 20 percent Recently diagnosed or receiving treatment (compared with) about 77 percent of children). “The recognized but untreated adult market is much larger and will continue to grow,” Goodman said. Woman – who like a girlthat is historically underdiagnosed-Probably a sizable share. Adults with ADHD may have suffered in silence until now, but growing awareness of the disorder, made possible by continued differentiation, will continue to increase the number of people seeking help. on social media There are many ADHD influencers.as well as a dedicated podcast on Spotify.
Until guidelines are published and incorporated into medical practice, the adult ADHD landscape will remain chaotic. Some people will continue to get prescriptions for Adderall they don’t need, and others won’t get the prescriptions for Adderall they need. do need. Rules alone couldn’t prevent shortages, and they probably won’t stop them now. But in many ways, their absence means that many who need help with ADHD will not get it.
