People Can’t Get Their A.D.H.D. Medicine, and That’s a Sign of a Larger Problem

By Maia Szalavitz of The New York Times. Excerpts:

"While the origin of the shortfall is contested, some blame rigid manufacturing quotas imposed by the Drug Enforcement Administration, which the agency hasn’t lifted despite increased diagnoses, insisting that the manufacturers have not used all of their existing allowances. The D.E.A. also has yet to provide a clear explanation of the shortage or to take emergency actions to help alleviate it.

The scarcity, which according to the Food and Drug Administration now involves the generic versions of the drug and not the brand name, has also been exacerbated by limits on supplies of all controlled substances to pharmacies, which were promised by distributors as part of opioid litigation settlements.

To make matters worse, the D.E.A. announced in February that it wants to end the pandemic-driven relaxation of telehealth rules that currently allow people who take drugs like stimulants and opioid treatment medications to get them regularly without requiring at least one in-person visit."

"These changes may seem unrelated, but they reflect an approach to drug policy that focuses on controlling supply — one that has backfired in fighting opioid addiction"

"But as the medical opioid supply contracted, the death rate skyrocketed. Overdose deaths rose as opioid prescribing quadrupled in the first decade of the 21st century, but more than twice as many people died from opioid overdoses in the following 10 years, when prescribing rates were falling back to pre-crisis levels between 2011 and 2021. At least two-thirds of all overdose deaths are now linked to illicitly manufactured fentanyl and similar synthetics, not prescriptions. In the past year alone, total overdose deaths topped 100,000."

"Though avoiding unnecessary prescribing for new patients may reduce addiction risk, stopping existing prescriptions for people who have pain, addiction or both does nothing to treat their underlying problems. Consequently, as the D.E.A. shuttered “pill mills” and legitimate doctors cut back, people with addiction turned to street drugs, which can be many times more deadly than pharmaceuticals. Patients in pain whose doses were reduced or eliminated were found to have a rate of suicide three to four times as high as those who continued.

"The D.E.A. has not succeeded at its mission. Its efforts are not associated with sustained changes in drug use, which has risen and fallen over the 50 years since it was created, even as the federal budget for the war on drugs exploded between 1981 and 2020 and as the D.E.A.’s own budget now stands at some $3 billion annually."

"Only once in its history has it completely eliminated a popular drug, methaqualone, from the black market."

"Reducing the accessibility of medications to people whose doctors believe that they are benefiting is never a great idea — especially for a group that is already prone to self-medication. Manufacturing quotas need to rise to meet existing demand for stimulants"

"patients who are suddenly cut off are likely to go to the streets."

"Moreover, increasing telehealth restrictions on access to opioid treatment medications . . . creates barriers to recovery, not to addiction."

"there is little evidence that telehealth-only prescribing did harm during the pandemic."

"the D.E.A. must drop the proposed new telehealth restrictions and ensure that quotas do not restrict legitimate access to controlled drugs."