With the worldwide shortage of attention-deficit/hyperactivity disorder (ADHD) medicines due to increased global demand and manufacturing problems, many patients and parents are feeling despondent in their unfruitful search for medication.

At the moment, some methylphenidate and atomoxetine medications are affected, as well as all lisdexamphetamine and guanfacine. A study found that 10,936 caregivers and adults with ADHD, roughly 38% of all patients have had trouble finding and filling their prescription medication over the past year and 21% continue to experience treatment disruptions today.

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Although medical staff are trying their best, this global shortage is out of their control.

That leaves parents and patients spending hours monthly in search of their medication from alternative pharmacies, an increase in doctor visits to transfer or rewrite prescriptions. In some instances, children and adults are now using less effective medication or go for months without medication due to the lack of resources to find alternatives or have the monetary means for the additional expense.

ADHD is the most common psychiatric disorder in children, affecting approximately 1 in 20, and follows about 65% of them into adulthood, affecting about 1 million adults in South Africa. If left untreated, the condition can hamper sufferers’ educational performance, self-esteem, relationships, and work productivity, and leads to increased risk of other psychiatric disorders, reduced social functioning, delinquency, and substance abuse.

By not using the correct medication, children can fall behind in school, struggle to manage their emotions and relationships, see a rise in depression, anxiety and an increase in impulsive behaviour that could harm them or others. Adults, if untreated, are also at risk as their interpersonal and work functioning may be affected, and the risk for developing comorbid mental health disorders, increases.

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Why is this happening?

ADHD medication is in high demand with prescriptions doubling from 2006 to 2026, and during the COVID-19 pandemic rising by 10%. The rising numbers raise concerns that perhaps people are being misdiagnosed, that medication is being oversubscribed and also misused for better performance, leading to the shortage in active ingredients to meet the increased demand.

The heightened awareness of ADHD the past couple of years has had a positive impact on early diagnosis and intervention, but negatively impacted the number of users with the demand increasing resulting in shortages worldwide.

Many people are also using ADHD medication for non-ADHD reasons stemming from a desire to increase their productivity and mental alertness, abusing the easier access and relaxed regulations brought on by the Covi-pandemic and telehealth, aimed at providing proper care to diagnosed patients.

The relaxed prescribing regulations brought on during the COVID-19 pandemic when fewer people were visiting their doctors but still needed their medication has certain contributed. With the rules loosened, prescriptions were done via telehealth making it much easier for people to receive access to medication and for in adequate evaluations and the inappropriate prescribing.

ADHD is not the only medication out of stock. Many other drugs to treat a number of conditions such as diabetes, are also victims of the failing pharmaceutical supply chain. The reasons for the delay are not clear as to the timeframe of how long this shortage will last.

How to best manage the situation

  1. Establish a relationship with your local pharmacy and create network of pharmacies you can use as resource to aid in your hunt.
  2. Some of the available products/tablets/capsules can be split into smaller doses and in some instances one can lower the dosage over weekends and holidays to keep a steady supply. During less active times ration the medication such as days where there is no homework and rather replace the medication with an active afternoon of sport or play.
  3. Consider a temporary switch to alternative medications
  4. Discuss with your psychiatrist about nondrug treatments and lifestyle management strategies. Up your exercise, decrease screentime, take omega 3/6 supplements, consider therapy to learn healthy coping mechanisms for time management and social skills.
  5. Be vigilant for the development of additional problems such as anxiety and poor self-esteem and monitor symptoms.
  6. Realise that your child or partner might require additional support during this time with empathy and tolerance.
  7. If you do not have ADHD consider the ethical implications if you do use medication for non-registered indications. The consequences are extremely severe for those patients who desperately need the medication but cannot find a steady supply.
  8. Healthcare providers must also adhere to guidelines and be thorough in their assessments before prescribing ADHD medication. A comprehensive assessment is needed to make sure someone indeed has ADHD and in the case of mild and moderate symptoms, consider complementary and alternative strategies, lifestyle interventions, and therapy prior to initiating controlled medications.