Finding ADHD medications will likely remain difficult in Wyoming

Madelyn Beck, WyoFile

For a long time, Nicole Foss wouldn’t even get behind the wheel of a car without taking her meds.

It seemed too high a risk, he said.

Foss is one of millions in the United States who have been diagnosed with attention deficit hyperactivity disorder. Without medication, it affects his ability to make reasonable, logical decisions, he said. He is also among those affected by a nationwide shortage of ADHD medications, a challenge that could last for years.

That shortage includes Adderall, Concerta, Ritalin, and other drugs.

That’s the highest logistics load for the people who can handle it least, Foss said.

Foss, a 24-year-old Laramie resident, has been on ADHD medication since the third grade. Due to federal regulations, however, people like her still have to go back to the pharmacy every month for a 30-day supply.

I understand why [the regulations] are in place, there is a high rate of abuse, he said. On the other hand, it makes it so difficult for people to get the help they need.

Foss knew drug shortages would come because both of his parents work in pharmacology. With her flow of medication decreasing, Foss said she had to go a few weeks without her regular her Concerta medication, using caffeine to help her through it.

I had headaches and stuff, Foss said. Withdrawal symptoms are not the worst. You can counter them with caffeine, which is what I did.

She had applied for Americans with Disabilities Act housing, but even that took time and energy.

Subsequently, Foss lost his job, jeopardizing his health insurance. He couldn’t afford the drugs without coverage.

Being 24, she was able to join her parents’ health insurance, but their insurer doesn’t operate in Wyoming, which means Foss has to drive to Fort Collins, Colorado for any covered drugs. It’s a trip she now makes on a regular basis, hoping the pharmacy at her doctor’s office has medications that work for her. For now, she takes several Metadate pills every day, hoping that her old drugs will become available again soon.

It’s just exhausting, she said.

Over the past 18 to 24 months, many people across the state and country have been impacted by these shortages—exactly how many is unclear. Even more could be affected in the near future, however, as new shortages and affordable prices are anticipated, generics may become harder to find.

Behind the counter

Foss is not alone in her frustration.

Recently, a patient at Sheridan’s Hospital Pharmacy West just exploded after workers were unable to provide that person with medication, according to Wyoming Pharmacy Association owner and president Matthew Meyer. That patient had already had to transfer all of his information to Meyers Pharmacy and now he couldn’t fill the prescription.

Originally, we were able to supply [their medication] for another three months, and now we can’t get it and they had to go look for it somewhere else, Meyer said. Your pharmacies were doing everything possible. We are looking at every available source that we can possibly use to try and get these drugs for our patients because the shortage has hurt us as well.

For some, these medications aren’t just needed to complete work and other tasks. There may also be withdrawal symptoms for those using higher dosages, including fatigue, sleep problems and depression.

People with ADHD like Foss need these drugs not to be highly effective superheroes, but to get us to the point where we can function like most people, he explained.

Meyer had heard that supply restrictions could ease by late June or early July this year, but now, weeks later, the hardships remain.

We are certainly a long way from being able to say that the supply chain is back to normal, corrected or even close to being completely corrected, he said. But [there has been] A step in the right direction.

How did we get here?

The shortage is almost as complex as the array of companies, regulations, and hands these drugs pass through.

The Food and Drug Administration said last October that the shortages were caused in part by production delays and insufficient supplies. Currently, the FDA is reporting shortages of Adderall and similar mixed amphetamine salts due to continued ingredient shortages and historic demand.

Increasing demand, in and of itself, is complicated. Broadening of diagnostic criteria and a general increase in awareness are likely contributing factors, especially for women and people of color, according to research published last year. TikTok, by itself, might spark some of that interest.

Regardless, supply can’t keep up. Beyond the ingredient shortages, the end of federal pandemic emergency measures led to more inspections of overseas plants, including ones that let things slide in subsequent years.

Since it started last year, we’ve seen several plants shut down for a variety of reasons: sanitary, quality control, Meyer said.

It can take up to six months to pass inspections again and restart shipping, he said. Even just getting your medications to pharmacies in Wyoming during the winter can be a pain due to frequent road closures.

Department store pharmacies can also have problems, Meyer added, saying their warehouses may ship drugs less frequently to pharmacies that don’t make as much money, such as those in rural Wyoming.

This is the biggest logistical burden for the people who can handle it least.

NICOLE FOSS

In Sheridan especially, our Walmart, our Walgreens tend to run out of product before we do, he said.

At the same time, some drugmakers have stopped making the same amount of generics because they don’t make them as much, Meyer added. Some generic drug manufacturers have even gone out of business.

Finally, there is the complicated, mind-boggling list of contractual agreements and requirements between drug manufacturers, distributors, pharmacies, hospitals, intermediaries and insurance companies.

Unfortunately, it’s extremely complex, he said.

The end result of those mounds of deals is that it can be more difficult to effectively overcome shortages or make sure pharmacies remain solvent and patients end up with the most affordable drugs, Meyer said.

What to do?

To control for shortages, companies like Teva, a maker of the Adderall brand, say they produce and distribute in line with historical levels. With growing demand and increasing numbers of people moving to some cities in Wyoming, old production levels just aren’t up to par.

You can appeal [to allocation amounts]he said, but during the shortage, it’s pretty tough to win an appeal.

Meanwhile, Meyer said some have turned to an alternative and Adderall-like ADHD drug called Vyvanse, but says even that may not be a reliable fallback in the future.

That’s just hearsay at this point, but you know, we’ve been told to prepare for a Vyvanse shortage, she said.

For some who have relied on telehealth to access these controlled substances since the start of the pandemic, there are also proposed federal rules that would require more in-person visits, though their implementation has largely been delayed until November.

As of Wednesday, Meyer said new projections show another 18 to 24 months of bumpy roads for those hoping to access the more affordable generic versions of some ADHD medications.

Those experiencing a shortage of a needed drug have options, Meyer says. One is to check around for other pharmacies, who may contract with a company that has more access at the time.

Another is to check with pharmacies five to seven days before you run out of a prescription so you have time to ask your doctor to send a script to another location or approve a drug switch if needed.

Foss does this on a regular basis.

Call as soon as you can, he said. Give yourself as much time as possible and do it every month.

Even beyond these, Foss said people need to start implementing their coping strategies in case their meds run out. Exercise helps, she says, but it’s not always possible to go for a vigorous run every few hours.

And both Foss and Meyer have talked about the possibility of having to switch ADHD medications, even though it took years to find one that worked better. Foss was lucky, she said, to have parents who could talk to her about her options.

My mom would say, these are the drugs that are pharmacologically similar to what you’re on. You can switch to a different drug with a different mechanism, but you’ll want to ask about these first because they’re in the same family of drugs, Foss said.

Foss looks forward to a day without drug uncertainty. Still, even then, she suspects the regulatory burdens, healthcare costs, crowded doctors’ offices, and stress of living with a chronic condition will remain.

The shortage will eventually stop, Foss said. But the logistical nightmare of being someone who needs ADHD medication, I think, will probably only get worse over time.

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This article was originally published byWyoFileand is republished here with permission.WyoFileis an independent, non-profit news organization focused on the people, places and politics of Wyoming.