If we don’t act fast, this shortage could trigger two major public health crises.
Many people who have been taking this amphetamine-based stimulant – whether prescribed for attention deficit or narcolepsy or used illicitly as a performance or party drug – will lose access. This carries serious physical and mental health risks.
Amphetamine withdrawal symptoms, including depression, are not easily addressed with other kinds of drugs. So as countless individuals are confronting having to rapidly taper or stop, we’re facing a real possibility of a public health disaster on a scale not seen since the prescription opioid crisis that began a decade ago.
The early 2010s taught us that dependence and addiction don’t simply disappear when the pills do. At that time, catastrophic regulation failures contributed to widespread opioid dependence and addiction. The government response to the prescription opioid crisis focused on rapidly reducing supply: crackdowns on pill mills, tightened restrictions on prescribing and reformulation of products to make them harder to snort and inject. This approach backfired, pushing many users onto the illicit market.
As a chemical analog of prescription opioids, heroin was widely available and far cheaper than its pharmaceutical cousins. But its unpredictable quality and link with injection drug use made heroin a much more dangerous alternative; the recent rise in fentanyl contamination has further fueled the crisis. Overdose rates have continued to soar, spiking from 16,000 during the height of the prescription opioid crisis to more than 100,000 annually. The number of cases of blood-borne infections like HIV and hepatitis has spiked in tandem.
Today’s Adderall shortage is setting up a similar crisis. For those losing adequate access to prescription amphetamine, illicit alternatives – especially methamphetamine – are readily available. Just as with heroin, years of increasingly punitive policies, aggressive law enforcement, government fear-mongering and growing public panic failed to address the “meth problem.”(...)
Enter the Adderall shortage.
A massive influx of people forced to switch from a pharmaceutical amphetamine to street methamphetamine would be nothing short of a nightmare. But there is still time to prevent a stimulant remake of the tragic scenario we have seen play out with opioids.
The F.D.A. has powerful tools at its disposal to ease the Adderall shortage. This includes attracting and fast-tracking approval for international manufacturers and helping rapidly develop domestic production.
Maintaining a reliable, safe supply of amphetamine medications is crucial to avoid a major public health crisis. Bigger thinking is also vital to prevent other similar crises from occurring in the future.
The current Adderall shortage is a symptom of deep structural dysfunction in our institutions, policies and systems responsible for drugs. As with opioids, stewardship of prescription stimulants in American healthcare is poor, often vacillating between excess and deficit. We need far more nuanced, patient-centered approaches to medication access that are not bogged down in drug panics and concerns about law enforcement.
Meanwhile, our streets are flooded with illicitly manufactured alternatives of unpredictable content and dosage, despite cavalier investments in criminal justice efforts to stem their supply. Instead, cost-effective lasting solutions like housing, social services, and wrap-around supports are necessary to make our society healthier and safer.
Bold actions are urgently needed to prevent history from repeating itself.
by Leo Beletsky, LA Times | Read more:
Image: JB Reed/Bloomberg via Getty Images
[ed. I don't know whether to laugh or cry. When Purdue Pharma's aggressive opioid marketing campaign eventually revealed abuses, everyone - government (Congress, CDC, FDA, DEA), doctors, hospitals, politicians, media, insurance companies - everyone, fell all over themselves to "get tough" on opioids. Supplies and prescriptions for pain medications were cut off almost immediately and long-term patients thrown under the bus. Guess what happened next? Widespread suffering, diverted drug seeking, increased and accelerating mortalities, spiking suicides, new drugs (fentanyl) filling the vacuum, and newly emboldened cartels making tons of money. Now Adderall is in short supply, but this time the affected population includes financiers, bankers, students, professors, billionaires, businessmen, media hacks, technology bros, Hollywood, and just about everyone else that needs a little bump to perform at an elevated level of performance. In other words, everybody. So I don't imagine this supply crisis will last long (or experience the same kind of pharmaceutical malpractice we've seen with opioids). See also: How L.A. Got Hooked on Adderall (LA Magazine); Amid the Adderall Shortage, People With A.D.H.D. Face Withdrawal and Despair (NY Times); also, Cat Marnell's memoir How to Murder Your Life.]
