What’s behind the shortages of Adderall, Ozempic and other drugs?
The shortage of drugs like Adderall is growing in the United States, and experts don’t see a clear way to solve it. For patients, this can mean treatment delays, medication changes, and other problems filling a prescription.
In recent months, unexpected spikes in demand, manufacturing issues, and tight ingredient supplies have all contributed to shortages that are distressing patients, parents, and doctors. For some medications, such as B. stimulants used to treat ADHD, several factors led to a deficiency and make it difficult to predict when it will end.
Shortages, particularly for generic drugs, are a long-standing problem. The industry has consolidated and some manufacturers have little incentive to fix shortages because cheap generics are making thin profits.
Here’s a deeper look at the problem.
How many drug shortages are there?
According to the University of Utah Drug Information Service, there were 301 active national drug shortages in the first quarter of this year. That’s 49% more than the 202 in the first three months of 2018.
Patients don’t feel all drug shortages because doctors may be able to substitute other drugs or because other parts of the drug delivery system are obscuring the problem, said Stephen Schondelmeyer, a professor in the University of Minnesota College of Pharmacy.
“But there are more bottlenecks now, and they’re becoming more visible,” he said.
Which drugs are in short supply?
In the fall, the U.S. Food and Drug Administration announced a shortage of Adderall, used to treat attention-deficit/hyperactivity disorder, due to a manufacturing issue. This has continued and at times grown to include other stimulants that treat the condition.
That situation appears to be improving, said University of Utah health researcher Erin Fox. But multiple extended-release doses of the drug, its most popular form, remain in short supply.
The FDA has also been tracking a shortage of the diabetes treatment Ozempic, which doctors also prescribe for weight loss. Prescriptions for Ozempic – touted by celebrities and others on social media – have doubled to more than 1.2 million since the summer of 2021, according to health data company IQVIA.
A spokeswoman for Ozempic maker Novo Nordisk says all doses of the drug are now available in pharmacies nationwide.
Last year, a rise in respiratory illnesses forced drugstore chains to temporarily restrict purchases of antipyretic drugs for children. There was also a shortage of the antibiotic amoxicillin at the time.
According to a recent report by Sen. Gary Peters, D-Mich. Chairman of the Senate Committee on Homeland Security and Government Affairs.
Why are there drug shortages?
The reasons can be different, and a combination of factors leads to many bottlenecks.
Adderall’s manufacturing problem arose as more and more people started taking the drug.
Prescriptions surged during the pandemic as regulators began allowing doctors to prescribe the drug without first seeing a patient in person. According to IQVIA, prescriptions for Adderall and its generic equivalents increased by 20% between February 2020 and late last year.
Adderall deliveries face an additional challenge when demand increases. Federal authorities limit shipments for the drug each year because it is a controlled substance.
For some drugs, pricing can also be a factor.
Ozempic is a diabetes drug. The same drug, semaglutide, is sold under a different brand name, Wegovy, for weight loss. Schondelmeyer noted that the milligram price for Wegovy can be more than double that for Ozempic.
“They have a run on Ozempic because people don’t want to spend that much on Wegovy,” Schondelmeyer said.
Allison Schneider, a spokeswoman for Novo Nordisk, said the price was unrelated to the scarcity. She coupled this with a combination of demand and global supply constraints.
Another factor driving shortages: Drugs like Adderall and amoxicillin generate low profits, so companies have no incentive to manufacture and stockpile large quantities if a shortage develops, Fox said.
“Once a shortage starts with something that you’re making just in time anyway, it’s really difficult to fix it unless all the suppliers are back,” she said.
How are patients affected by drug shortages?
Bottlenecks can lead to delays in treatment, which can harm patients struggling with time-sensitive conditions like cancer.
Doctors are sometimes forced to prescribe alternatives that may not be as effective. This, too, can lead to medication errors if the doctor is less familiar with the other medications.
Patients may also run out of prescriptions or be forced to search for a pharmacy that has enough stock to refill them.
It’s difficult to predict when many bottlenecks can be resolved, in part because measuring demand is difficult.
“You can expect to increase your production by 10%,” said Mike Ganio, senior director of pharmaceutical practice and quality at the American Society of Health-System Pharmacists, “but will that be enough?”
Meanwhile, conditions still exist that could fuel future shortages. The Senate report cited over-reliance on foreign sources as a concern.
Factories in China and India provide most of the raw materials for American medicines. At the start of the COVID-19 pandemic, India restricted the export of 13 active pharmaceutical ingredients and finished medicinal products made from these chemicals to protect its domestic drug supply.
Once bottlenecks arise, they can last for years. And it can be difficult for patients to get reliable information. Fox said there is no legal obligation for drugmakers to keep the public informed.
The Senate report notes that “no federal agency or private industry partner has end-to-end visibility into the entire US pharmaceutical supply chain.”
Fox says the lack of stimulants was particularly frustrating. Companies have said they aren’t getting enough raw materials to make the drugs, and the federal government says companies aren’t using what they have.
“There was a lot of finger pointing,” Fox said.