A shortage of drugs used to treat attention-deficit hyperactivity disorder has Jenni Heiner on the hunt.
Her kids, plus she and her husband, have the disorder. For the past year or so, the family from Ivins has had trouble getting their prescriptions filled due to a national shortage.
"I call every pharmacy in town until I find one that has it and I zip over there," said Heiner, who noted she often must hit three to four pharmacies to fill the family's monthly prescriptions. "It's extremely inconvenient."
The Food and Drug Administration as well as a national pharmacists association say there are shortages of the short- and long-acting versions of Adderall and its generic brands.
Patients aren't necessarily going without medication, but they may have to use different drugs while they wait for the supply to increase.
"This is a chronic medication it's not something you want to spend half a day trying to fill a prescription," said Erin Fox, manager of the Drug Information Service at the University of Utah.
Manufacturers cite production problems, increased demand and Drug Enforcement Administration quota restrictions for raw materials as an explanation for the shortages. However, some companies have not offered an explanation to the Drug Information Service, which monitors drug availability on a national level for the American Society of Health-System Pharmacists.
"They're under no obligation to provide a reason," Fox said. "Often they will provide an explanation to the FDA but in many cases they ask the FDA to keep that information confidential."
The shortage causes angst for pharmacists, too.
Two or three months ago, supplies started to get "spotty," said Chris Cox, owner of Smith Rexall Drug in Pleasant Grove. "Now I can't get anything."
Cox offers to help patient locate pharmacies that have the drug in stock. But as the shortage has worsened, patients have had to turn to other therapies, such as Ritalin or the more expensive, extended release version of Adderall, called Adderall XR, if it's available.
Substitute therapies don't always work as well for patients, said Cedar City Republican Rep. Evan Vickers, owner of Bulloch's Drug. "A lot of patients have already been on Ritalin before and it was unsuccessful," he said, "and that's why they're on Adderall."
It can take one to three months to get the dosage right on a new drug, Vickers said.
The pharmacists society says the pharmaceutical companies Teva Pharmaceuticals and Global Pharmaceuticals either cannot give a reason for their shortages for the extended-release capsules, or they blame it on increased demand. While the society says Adderall XR is available, the FDA lists Adderall XR on its current drug shortage list, noting there is uneven product distribution patterns.
A spokesman for Shire, which distributes Adderall XR, said there is currently "no supply issue" with the drug's long-acting version. "There had been some spotty distribution of XR earlier this year and that issue has been resolved," said spokesman Matt Cabrey.
When it comes to the immediate-release tablets, the Adderall version from Teva as well as the generic versions made by Sandoz and CorePharma are also in short supply, according to the pharmacy society and the FDA. CorePharma is primarily shipping its supply to Walgreens, according to the pharmacy society Web site. Sandoz said its supply is on "intermittent back order."
Teva blames the shortage on restrictions by the U.S. Drug Enforcement Administration on amphetamines, which are needed to make Adderall.
The DEA has denied any restrictions that would affect supply.
"We don't agree there's a shortage of amphetamine salts [used to make the drugs]," said DEA spokeswoman Barbara L. Carreno. "We control the active ingredients in the medication. We have no involvement with how the active ingredient is used."
Vickers said wholesalers have tied shortages to raw materials.
This happens from time to time, he said. "The price starts low. We're told there's a shortage and when they come back, they come back at a higher price."
Vickers wouldn't go so far as to say that drug makers are creating demand by artificially straining supplies, but said, "It looks fishy. It makes you wonder."
LynDee Royce of West Jordan said the price for her daughter's Adderall prescription has fluctuated from $75 to $300. When 30 mg pills aren't available, she buys them in 15 mg form.
"With changes like this I have to change the order at school or they won't give it to her," Royce said, adding that the extra costs have been hard to shoulder in a tight economy.
Heiner's family takes the generic form of Adderall XR. If Heiner can't find the long-acting version, her children have to use the short-acting kind, which she says causes them problems.
She wonders if the shortage of the generic is due to more families having to use the less expensive version because of hard economic times.
"They can't concentrate and they can't focus. They miss little details when things are due," she said. "With [proper] medication, things are so much more manageable."
Tribune reporter Julia Lyon contributed to this story.
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Other drug shortages
Adderall isn't the only drug in short supply.
The country is in the throes of a record drug shortage that is delaying care and distracting providers who must spend time rationing supplies and hunting for alternative therapies. Hardest hit are life-saving injectable medicines, cancer treatments and antibiotics.
Commonly cited causes for shortages are federal recalls, manufacturing glitches and corporate decisions to discontinue less profitable medicines.
Legislation to remedy the problem has been hung up in Congress for months.
To cut through the gridlock President Barack Obama last week signed an executive order directing the Food and Drug Administration to press drugmakers for advance notice of shortages and notify the Justice Department of sellers charging exorbitant prices for scarce medications. The order also directs the FDA to speed review of manufacturers that are stepping up production to address shortages.