Drug shortages leave Northland patients unable to fill prescriptions

• Ritalin

A nationwide shortage of Ritalin, Adderall and other drugs commonly used to treat attention disorders has left many patients unable to fill their prescriptions. (File / McClatchy Newspapers)

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With two sons ages 8 and 6 who depend on medication, the last thing Margo Baker needs to deal with is supply shortages.

“Every time I go to the pharmacy, every month, either they don’t have my sons’ meds, or they have to owe me some, and I have to go back a few days later and get some,” the Cloquet woman said on Friday. “Now this last time we couldn’t get them at all.”

Between them, Baker’s two boys take three different strengths of Adderall, a drug that’s widely prescribed for attention deficit disorder. With it, her boys are fine, she said. Without it, they can’t cope with school, and she has had to keep them home for as long as a week.

“It’s pretty hard when a 6-year-old is bawling their eyes out and looks at me and says, ‘Mommy, what’s wrong with me?’ ” Baker said.

The shortage of Adderall, Ritalin and similar drugs has been playing out nationwide for months. It peaked in the fall after first surfacing in May, said Erin Fox, manager of the University of Utah’s Drug Information Service, which tracks drug availability nationwide for the Food and Drug Administration. It has been more acute for Adderall, which is a composite of three kinds of amphetamine salts, because it has fewer manufacturers than Ritalin.

Robert Elfinger, a spokesman for Walgreens, said the pharmacy chain continues to offer Adderall, “but we urge customers to call their local Walgreens to confirm availability.”

It’s one of numerous shortages that made 2011 the worst year for drug availability in the 10 years she has been tracking it, Fox said.

Sen. Amy Klobuchar, D-Minn., who is author of legislation to address drug shortages, said the number of drugs with shortages rose from 55 in 2005 to 231 last year.

For the attention disorder drugs, the worst may be over, Fox said.

“There are still shortages, specifically of the Adderall products, but the companies … are starting to release products again,” Fox said. “Unfortunately, it’s very spotty.”

Charley Korsch, pharmacist at Arrow-Pasek Pharmacy in downtown Duluth, has had to “pretty much restrict them to my existing clientele” because of the short supplies, he said.

Sitting at his computer on Friday afternoon, Korsch typed in “methylphenidate,” the stimulant in Ritalin, to see what was available from his wholesaler. Prices for various formulations ranged from $6.59 for a bottle of 100 to $787 for a bottle of 100. The less-expensive varieties tended to be out of stock, unavailable, or available only in restricted quantities, he said. Those priced $400 or more generally were available without restriction.

It was similar for Adderall.

The profit motive may determine what brands are available from manufacturers, Korsch suggested. “As a logical manager, you would make sure that your high-profit items were guaranteed to be in supply,” he said.

Novartis, which manufactures Ritalin and generic forms of Ritalin and Adderall, has experienced increased demands for those products because of competitors’ shortages, said Julie Masow, spokeswoman for the New York-based corporation. As a result, Novartis is experiencing “intermittent, short-term shortages” of its own, she wrote in an e-mail.

“There is currently not enough product to fill all of our customer orders at the wholesaler level,” she wrote. “We are working diligently to supply the demand for these products for appropriate parents.”

An e-mail query to Shire, the maker of the brand-name form of Adderall, was not answered.

The medications also are used to treat patients with narcolepsy and other forms of excessive sleepiness, said Sharon Yung, a nurse practitioner in the Sleep Clinic at Essentia Health in Duluth. Those patients, too, are affected by the shortages.

“It’s very difficult for the patients to obtain these when there’s a shortage, and obviously it can affect them in their life, in their functioning,” Yung said. “It’s a challenge for the patients, and it’s an inconvenience.”

What complicates the shortage for all three stimulants is that they are made from controlled substances regulated by the Drug Enforcement Administration, Fox said. Adderall, for example, is a combination of three kinds of amphetamine salts. The DEA limits the amount of controlled substances drug manufacturers can use.

“Some of the companies have said it’s a DEA problem,” Fox said. “The DEA says it’s not.”

Jeffrey Scott, special agent for the DEA, said the agency seeks to avoid shortages.

“It is our committed goal to ensure there is an uninterrupted supply of controlled substances to meet medical and scientific needs,” Scott said. “What we have seen is that there have been perceived shortages because certain formulations and certain dosages are not readily available. … That’s not a shortage of amphetamine salts. That’s a shortage of a particular brand.”

Although some manufacturers blamed the DEA for the shortage, others didn’t list a cause, Fox said. “The companies don’t have to disclose that to anybody. They don’t even have to tell the FDA if they don’t want to.”

That’s one of the things that Klobuchar’s legislation would change, she said this week. It also would require manufacturers to give the FDA early notification when drug shortages are anticipated. Now, “the FDA finds out when the pharmacies start calling them,” Klobuchar said.

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