Doctors in England have been told not to prescribe ADHD drugs to new patients because of a national shortage, as charities warn that the supply problems are devastating for people living with the condition.
A national patient safety alert from the Department of Health and Social Care said the shortages were down to a combination of manufacturing issues and increased global demand, and could last until the end of the year.
ADHD, which stands for attention deficit hyperactivity disorder, is described by the NHS as a condition that can make it hard to concentrate and may mean people act on impulse.
Prescriptions for ADHD have been rising in recent years. Figures for April to June 2023 show that about 202,000 individuals in England received one, up from 103,000 in the same period in 2018-19.
With about 2.2 million people in England thought to have ADHD, experts say the condition is under-diagnosed and under-treated.
Now prescribers have been told not to start new patients on medications affected by the shortages until the supply issues have been resolved.
The medications affected include methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.
“Other ADHD products remain available but cannot meet excessive increases in demand,” the DHSC alert states. “At present, the supply disruptions are expected to resolve at various dates between October and December 2023.”
Advice has also been given that healthcare professionals should identify all patients currently prescribed these products, check how much supply they have remaining and contact various dispensing pharmacy services or the patient’s specialist team for advice should their supplies be running low.
Henry Shelford, the CEO and a co-founder of ADHD UK, said: “ADHD is a disability and the sudden removal of medication is akin to removing a wheelchair from a disabled person that needs it. The NHS should have realised that this was happening and had a plan in place. Instead, people are only finding out when their pharmacy can’t supply. They’ve been left stranded with no support. It is an abject failure, but sadly this lack of care is something we’ve come to expect with our stigmatised condition.”
Shelford criticised the DHSC advice. “The Department of Health and Social Care sticking-plaster memo with the suggestion that GPs ‘reach out to a patient’s specialist team’ is laughable,” he said, adding that patients often waited years to meet the medication team.
“Medication is carefully given with dosage and type worked out over months. The idea it can be chopped and changed is wrong. The idea that specialist teams have the capacity to do medication reviews in this quantity is wrong,” he said.
“This is devastating for individuals across the country and will be life-changing for some. People with ADHD are being let down by the NHS. This is just the latest way in which we are being failed.”
Sheldon said the situation was also of concern for those hoping to start treatment for ADHD. “It’s going to be devastating for those diagnosed [who are] waiting to receive medication now knowing they have to wait even longer,” he said.
The current shortages are not the first to affect ADHD drugs this year. The DHSC previously warned of a shortage of atomoxetine capsules, a situation that is not expected to be resolved until next month.
Dr Andrew Hill, a senior visiting research fellow in the department of pharmacology and therapeutics at the University of Liverpool, said the problem lay in how medicines were sourced.
“The NHS often depends on only one or two foreign suppliers for key medicines. If these factories fail to supply, there is a high risk of shortages,” he said. “We had many problems during Covid when drug production was suspended in China and India. Last year there was a major shortage of amoxicillin to treat respiratory infections.”
He said a new approach was needed. “The European Union is passing new laws to safeguard supplies of critical medicines. Manufacturers need to send alerts if their supplies are at risk. It is time for the UK to do the same.”
A Department of Health and Social Care spokesperson said: “We are aware of supply issues affecting medicines used for the management of ADHD due to increased global demand, and we have issued communications to the NHS to advise healthcare professionals on management of patients during this time.
“We continue to work closely with the respective manufacturers to resolve the issues as soon as possible and to ensure patients have continuous access to ADHD medicines in the UK.”
Entire manufacturing processes and pipelines work on a just in time system. When perfectly efficient, money is saved in storage of inputs and outputs. This add to the margin of product considerably. This lead to the approach being adopted in many industries.
However, one little bump in the road and the effect travels across all the process like a tidal wave. Effecting every business involved that uses a just in time system.
This is the downside of this type of approach. A complete lack of robustness in the manufacture and supply of goods.
Not only does it lack robustness. These systems are so tight that the faults that occur. Will can continually keep reoccurring unless extra capacity is built.
Why don’t they resolve these issues with extra capacity. Extra capacity costs a lot. It is also extra, unnecessary capacity once the immediate problem is resolved. This hurts the margin on the products being produced. So businesses are unwilling to increase capacity to resolve the issue, unless that capacity can will create more demand. Demand that would fully utilise the extra capacity.
So the capacity is only installed if it will eventually be saturated. With saturated demand, the system is at that critical point of maximum profit margin and minimum robustness. All it takes is another little bump in the road and the whole problem loops back around again.
Possible solutions:
Regulation. Governments could mandate that the capacity to produce medication must exceed demand so this doesn’t happen. In countries with nationalised health systems this can be achieved through normal medicine procurement. The health service only uses a supplier if it can meet demands.
Stock pilling. This costs the government money and puts the supply risk on the government. It also causes the businesses producing medication risks. Because the government can uses it’s stockpile to extort them through market control. This also causes diplomatic issues as many medications are globally produced.
Increased competition. All medications that are recommended for prescription should have an alternative, preferably multiple. This discourages such tight supply chains. As any downtime would lead to a loss in market share.