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Dr. Kacir's ADHD Blog

ADHD in the media

Short-acting ADHD medicine shortages in the news

The New York Times and The Boston Globe both ran articles about the shortages of generic ADHD medicines on New Year's Day.  The Times described a tug-of-war between the FDA and the DEA regarding its cause...and even its existence!  A spokesman from the DEA stated that there were plenty of ADHD medicines.  He went on to say that the problem was that manufacturers had chosen to make more brand name medicines rather than funneling their allotted active ingredients to the cheaper generic drugs.  He did not address the fact that companies which make only generic medicines suffered equal shortages nor did he acknowledge the shortages of brand name versions as well.
 
According to the articles, the DEA believes that the increased demand for Adderall is principally abusive.  One statement described college students taking the pills to stay up all night and liking the sensation so much that they continued to use it after they graduated.  Another DEA spokesman cited the ongoing shortages of non-controlled generic medications as being evidence that DEA regulations did not contribute to the shortage of controlled generic medicines.  (Manufacturers of "old fashioned" generic injectable medicines have stopped making them in favor of newer medicines that bring in more profits.  This is causing problems in hospitals since the "tried and true" remedies are often safest and most effective for the majority of patients.)
 
The Food and Drug Administration (FDA) on the other hand, has been fielding dozens of calls every day from patients who cannot get their legitimate prescriptions filled.  Spokesmen from CHADD and an organization of child psychiatrists both cited serious problems for patients who risked school failure, car crashes and job losses without their prescribed medication.
 
Personally, I am conflicted about the issue.  On the one hand, there is a big problem with the abuse and misuse of stimulants.  Regulation by the DEA and DPS is necessary at all levels: manufacturers, distributors, pharmacies, prescribers and consumers.  The short-acting generics are more likely to be abused than are the more expensive, longer-acting medications and so there is some justification for limiting the availability of the short-acting substrates.  On the other hand, some patients simply cannot afford the higher priced pills with better availability.  There are also patients who  do not tolerate the longer acting medicines and others for whom they do not work as well.
 
The good news is that regulations have allowed for more medications to be available in 2012 than were present in 2011.  It remains to be seen whether the increases are sufficient to prevent any shortages... and whether abuse becomes more common.  It will be interesting to review the investigations of stimulant misuse and abuse.  Which side of the controversy would be supported if the number of reported violations was significantly lower than expected?

ADHD in The New York Times

Perri Klass, M.D. wrote an article for The Times that summarizes the current science regarding ADHD.  It is entitled "Untangling the Myths about Attention Disorder."  She starts by contradicting the theories that today's world  breeds more problems with attention that are then diagnosed as ADHD and she rejects the use of ADHD as a metaphor for functioning in that world. She goes on to state that ADHD is a true disorder that goes beyond excessive multitasking.  In support of this premise, she references the first medical journal description of ADHD (although it wasn't called that) in 1905 and an 1845 poem entitled "Fidgety Philip" which described the disorder in rhyme.  She also refers to the imaging studies which have illustrated anatomic differences between children with ADHD and those without as well as the functional studies that show decreased brain activity in areas which control attention that can be corrected with stimulant medication.  What was most interesting to me was her discussion with Dr. Maximillian Muenke, the head of the medical genetics branch of the National Human Genome Research Institute.  His group has identified a specific gene associated with ADHD in some families that also seems to signal a good response to stimulant medication.  He predicted that in the future, genetic analysis might be able to indicate which patients with ADHD would respond to which medications or behavioral therapies.

ADHD on aol

I was quite surprised to see a headline on the aol home page entitled "What is the cause of ADHD?"  I read the blurb on the "front page," and it suggested pesticides, diet and "bad parenting," but went on to say that "experts separate fact from fiction."  I was pleased to read the main body of the article which used Dr. Wolraich as their primary expert.  He has been part of many academic studies on ADHD.  He denied that foods like refined sugar and food additives could cause ADHD, but did support regular mealtimes and a balanced diet, with a multivitamin for picky eaters.  There was no mention of increased Omega-3 fatty acids having a beneficial effect, although more than one study supports their use in ADHD.  He did acknowledge a recent study which found that there was a higher rate of ADHD in a group of children with higher levels of pesticide residue in their urine than there was in the group with the lowest levels studied.  His recommendation was either to buy organic fruits and vegetables or to wash non organic produce very well before eating it.  In summary, it was good to see that aol was providing reliable and responsible reporting on ADHD.
 
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