MHM Magazine

With the worldwide shortage of attention-deficit/hyperactivity disorder (ADHD) medicines due to increased global demand and manufacturing problems, many patients and parents are feeling despondent in their unfruitful search for medication. At present, some methylphenidate and atomoxetine medications are affected, as well as all lisdexamphetamine and guanfacine. A study found that roughly 38% of all patients have had trouble finding and filling their prescription medication over the past year and 21% continue to experience treatment disruptions today. Although medical staff are trying their best, this global shortage is out of their control. This leaves parents and patients spending hours monthly in search of their medication from alternative pharmacies, an increase in doctor visits to transfer or rewrite prescriptions. In some instances, children and adults are now using less effective medication or go for weeks or even months without medication due to the lack of resources to find alternatives or have the monetary means for the additional expense. The heightened awareness of ADHD the past couple of years has had a positive impact on early diagnosis and intervention and increased the number of users worldwide. Unfortunately, there are also some individuals being misdiagnosed, medication is being sometimes oversubscribed and even misused for perceived better performance. This increased demand for medication, as well as strict regulations in terms of production, are leading to the shortage in active ingredients for the medication. The relaxed prescribing regulations brought on during the COVID-19 pandemic when fewer people were visiting their doctors but still needed their medication has certainly contributed. With the rules loosened, prescriptions were done via telehealth making it much easier for people to receive access to medication and for inadequate evaluations and the inappropriate prescribing. HOW TO BEST MANAGE THE SITUATION 1. Always adhere to the established guidelines in managing ADHD. Do a comprehensive clinical assessment to establish the diagnosis BEFORE initiating treatment. 2. In the case of mild and moderate symptoms, consider complementary and alternative strategies, lifestyle interventions, and therapy prior to initiating controlled medications. 3. Emphasise the importance of nondrug treatments and lifestyle management strategies. Up exercise, decrease screentime, take omega 3/6 supplements, consider therapy to learn healthy coping mechanisms for time management and social skills. 4. Establish a relationship with your local pharmacies and medical representatives which you can use as resource to assist in sourcing medication for your patient. 5. Some of the available products/ tablets/capsules can be split into smaller doses and in some instances one can lower the dosage over weekends and holidays to keep a steady supply. During less active times ration the medication such as days where there is no homework and rather replace the medication with an active afternoon of sport or play. 6. Consider a temporary switch to alternative medications. 7. Be vigilant for the development of additional problems such as anxiety and poor self-esteem and monitor symptoms. 8. Consider the ethical implications of off-label/ non-ADHD use of medication. The consequences can be severe for those patients who desperately need the medication but cannot find a steady supply. 9. Healthcare providers must also adhere to guidelines and be thorough in their assessments before prescribing ADHD medication. References available on request. Substance Trade name Formulation Doses Dosing strategy Clonidine HCl Equi Menoglo Drops ® 0.025mg/5ml sol Initiate at 0.025mg bd po and increase gradually to a maximum dose of 0.075mg bd po. Menograine ® 0.025mg tabs Modafinil Provigil ® Modafinil 100 iPharma ® 100mg tabs Initiate at 100mg/day po. Can be increased to 200mg/ day po. Armodafinil Nuvigil ® 150mg and 250mg tabs Initiate at 150mg per day po. Can be increased to 250mg/day po. 8 | MENTAL HEALTH MATTERS | 2024 | Issue 1 MHM