Running on Empty: How Alaskans Cope with a Stimulant Medication Shortage

Those 1 to 3 percent of Alaskans have noticed since last year that methylphenidate, lisdexamfetamine, and amphetamine salts—the generic versions of Ritalin, Vyvanse, and Adderall—have sometimes been unavailable when they try to refill prescriptions.

According to Cutchins, drug shortages are not rare—most people just do not realize they are happening. Usually, they’re older drugs, slowly being replaced or facing short-term production issues. “At any given time, hundreds of medications have limited accessibility,” he says.

Two factors have been contributing to stimulant medications being in short supply. First, some pharmaceutical companies have either ceased producing them or have gone out of business. Second, pharmacies have had an increased demand to fill stimulant prescriptions.

Pharmaceutical companies are not required to provide detailed updates to the public about gaps and delays or to estimate when consistent production and accessibility will resume. That said, people can learn some information online on the US Food and Drug Administration website and the American Society of Health System Pharmacists (ASHP) websites. Both sets of web pages have summaries about drug shortages and discontinuations and estimated resupply dates. The ASHP web page also includes reasons for the shortages, if known, and provides related available and alternative medications.

Complications surrounding the stimulant shortage have been amplified for patients with conditions that are treated by these medications, namely due to their being controlled by the US Drug Enforcement Administration. Alaskans with these prescriptions cannot request pharmacies to transfer their scripts, so they are faced with two options. They must either rely on their clinics to call other pharmacies (while hoping the medications remain available until pharmacists can fill their prescriptions) or take paper copies themselves from pharmacy to pharmacy until they can find one that can fill them.

“Most drug shortages occur in three-month increments and continue on three-month rolling bases,” Cutchins says, “which means we’ll know a resolution is coming three months before the deficit ceases.” Then the drug supply can return to its pre-shortage availability. Cutchins adds that he recently learned in a national call that stimulant medication manufacturing is beginning to resolve.

Cutchins offers tips for Alaskans who are experiencing shortages with their medications—be they stimulants, pain-relief, or other prescription drugs. “Involve everyone on your care team, and don’t count on electronic health records to do the work for you,.” he says. “Communicate proactively with your primary care provider, your specialists, your pharmacists, your counselors, even your case managers, if you have them.”

Even practitioners on care teams who have no control over prescribing or filling medications, let alone resolving shortages, can still support patients who are struggling to access and consistently take drugs for their conditions. “The more people who know what you’re facing, the more people who can help you,” Cutchins notes. Doctors, physician assistants, nurse practitioners, and counselors can point Alaskans to alternatives, whether prescription, over- the- counter, or therapy-based. However, Alaskans should avoid turning to medications that are produced and distributed outside the United States since they lack the Food and Drug Administration’s and Drug Enforcement Administration’s oversight, stringency, and controls.

“I want to acknowledge how hard this shortage has been for a lot of people,” says Cutchins. “Patients deserve to have their experiences validated. Hearing that others understand their difficulties and realize the impacts this shortage is having on them matters, especially when they’re facing something hard.”