Does the ADHD Drug Shortage Herald a Crackdown on Stimulants?

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With the Obama administration characterizing prescription drug misuse as this generation’s crack epidemic, something like this seemed fated to happen: patients, pharmacists and manufacturers are reporting a serious shortage of medications to treat attention deficit hyperactivity disorder (ADHD) due to a hold in 2010 by the DEA on the drugs’ main ingredients.

Given the crackdown on doctors who prescribe pain drugs like Oxycontin and widespread concerns about the use of illegal methamphetamine, I’ve long wondered why a similar assault was never launched on prescribers of amphetamines. After all, some prescription drugs for ADHD actually contain methamphetamine — the same exact drug that is reported to damage the brain, cause cognitive impairment and be irresistibly addictive. Other hyperactivity drugs like Ritalin and Adderall include compounds that are close pharmacological relatives.

What’s more, a recent study suggested that as many as one in four people seeking an ADHD diagnosis from doctors are faking their symptoms to get the drugs, so why hasn’t there been a similar clampdown again prescriptions for stimulants — like that we’re seeing now against drug prescriptions for addicts who fake pain?

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The reason surely can’t be found in the data. The research shows that amphetamines, when taken in therapeutic doses, improve mental functioning and in the vast majority of cases do not lead to addiction. Indeed, some research suggests that children who have ADHD and are given appropriate medication are less likely than those who go untreated to develop addictions later in life. The opioid data is similarly reassuring: taken as prescribed, these painkillers are safe and effective, resulting in new addictions only in a tiny proportion of patients.

If the research on drug safety can’t explain a war on painkillers but not on Adderall, then maybe it has to do with misuse — namely, the fact that opioid overdoses are far more likely to cause death than stimulant overdoses. Opioid overdose has outpaced car accidents as the leading cause of injury-related death in 17 states. But lack of overdose deaths doesn’t stop politicians from cracking down hard on crack and illegal methamphetamine.

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Could the current shortage of ADHD drugs be a shot across the bow? Perhaps the DEA’s delay last year in releasing extra supplies of the medications’ active ingredients — which now has patients in many states scrambling to get their prescriptions filled at multiple pharmacies or paying higher rates for pricey brand names instead of generics — was a warning that the government is turning its attention to whether the increase in demand for the drugs represents real medical need.

Could it be that ADHD patients are about to get familiar with the predicament of pain patients — being seen as guilty of addiction until proven innocent — and that their doctors may soon be prosecuted for failing to police them?

My suspicion is that a major war on prescription stimulants is unlikely. The main reason is this: unlike opioids, Ritalin and similar drugs are considered as aids to productivity, “cognitive enhancers,” not fuel for idle pleasure. Those who use ADHD drugs off-label are thought of as CEOs, programmers and college students who want a competitive edge — not as nodding junkie dropouts faking pain on the couch or, for that matter, as rural speed freaks.

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Despite the fact that opioids actually increase productivity in pain patients, just as stimulants do for people with ADHD — by getting them back to work and family life — this is not these drugs’ main public image. And, unfortunately, when it comes to dealing with drugs, image trumps research and symbolism beats effective policy every time.