Prescription Drug Shortages – The New York Times

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Americans are facing shortages of some key drug treatments.

Some cancer patients struggle to get chemotherapy drugs. Antibiotics are scarce after a severe flu season. Treatment for attention deficit hyperactivity disorder. Even children’s Tylenol has become hard to find, as my friend Christina Jewett wrote.

“This is, in my opinion, a public health emergency,” said Dr. Amanda Fader of the Johns Hopkins School of Medicine.

Today’s newsletter will focus on ADHD drug shortages, which reflect many of the wider drug supply problems. The Food and Drug Administration first acknowledged the shortfall in October. Patients complain that they have to shop at pharmacies to get medicine, if they can find it. And without these drugs, many say they don’t work.

Edward DiNola, a programmer and game designer, told The Times that taking the ADHD drug Adderall had made his sleep schedule less predictable. After a week without the drug, he fell asleep one day at 7am.

The wider shortage reflects supply chain problems for generic drugs, which make up 90 percent of prescriptions. But the lack of ADHD medication is more because it has been affected by brand-name products, such as Adderall, as well. That leaves more people without the medicines they need.

One reason for the shortage of ADHD drugs: The use of these drugs has increased in recent years. From 2020 to 2021, prescriptions increased by more than 10 percent in many age groups, a new CDC study found.

Why? Experts point to the collision of two new trends in the US: the increasing number and recognition of mental health problems, and policy changes brought about by the Covid pandemic that increase the use of telemedicine.

First, activists and policymakers have pushed Americans for decades to take mental health issues more seriously — to see them not as moral failings or character defects, but as health problems that require treatment.

ADHD is an example of this acceptance. Experts have long believed that it mostly affects teenagers. In recent years, activists and patients have argued that ADHD can be a lifelong and underdiagnosed and undertreated condition among girls and adults. Opinions have been rising, despite some criticism that ADHD has been overdiagnosed in boys who are then treated with potentially dangerous stimulants.

Second, telemedicine got a big boost during the pandemic, as policymakers and medical facilities tried to limit in-person doctor visits. The shift not only allows existing patients to continue treatment, but also allows treatment for new patients who have never traveled to a doctor’s office or hospital before.

These two trends act together to increase demand for ADHD treatments. As more people begin to take their mental health more seriously, they have more access to treatment. So there are more medications for ADHD

Beyond demand, a number of issues can limit the supply chain. Drug companies claim that government-set quotas have hindered supply, although the Drug Enforcement Administration says companies have not used what they have. Some pharmacies also argue that tougher rules for opioid painkillers have spilled over to other drugs, making it harder to get needed supplies.

For generic drugs, there is a more systemic problem. Companies are under constant pressure to offer the best possible prices, and they often cut corners to reduce costs and keep prices low. That makes them not ready to increase supply if needed, for example, demand increases.

All of these factors may play a role in ADHD drug shortages, said Erin Fox, a drug supply chain expert at the University of Utah. But because so much of the drug supply chain is unclear, it’s hard to know what went wrong.

The lack of transparency itself is a problem, not only for ADHD drugs but for other drug shortages. If the public and policy makers do not understand what is wrong, they cannot help find solutions.

For more: Drug shortages may worsen, experts say.

An ancient book known as the Codex Sassoon – the oldest and most complete Hebrew Bible – sold for $38 million yesterday. Even in his day, the book was an expensive item, requiring the skins of more than 100 animals to make the parchment leaves. Experts think it could be the most expensive book ever sold, but it won’t match the record set two years ago by selling the first printing of the US Constitution.

The documentary “Anna Nicole Smith: You Don’t Know Me” is short on insight.

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