Adderall Shortage Sparks Overdose Spread
It had to happen. Adderall was always bound to make the increasingly lethal list of top-selling fentanyl-laced counterfeits. After all, drug dealers were highly unlikely to miss such a wildly popular drug. Nevertheless, it didn’t have to happen like this. Tens of thousands turning to unscrupulous sources in order to fill their prescriptions. What about the pharmacies? Why can’t they continue to fill these prescriptions? And why are there so many Adderall prescriptions to fill anyway?
Those are the billion dollar questions. Yes, billion with a “b.” And we mean that quite literally. Because that’s just the kind of money long generated by Adderall. It’s also the kind of windfall due to the party that can keep providing the requisite pills.
A Perfect Storm… and an Epidemic Reprise
The current crisis feels suspiciously like the Opioid Epidemic all over again. Back then, of course, the issue was OxyContin. Sure, Percs and Dillys and some of Oxy’s other pain-killing brethren had also become an issue, but Oxy was by far the main culprit. Then again, when the inventor of miracle medicine marketing pushes a product, that product is gonna be heavily featured.
And Purdue Pharma were the ne plus ultra of medicine marketeers. In fact, the company’s marketing of Oxy was so wildly successful it funded university programs and museum annexes. It also spawned a veritable cottage industry of books, films and television shows, killed over a hundred thousand Americans and cost the country upwards of one trillion dollars.
You know the story: Purdue persuades legions of MDs to freely prescribe “safe and effective” OxyContin and hundreds of thousands of Americans wind up addicted. Then, when authorities turn off the pain pill spigot, those addicts are forced to turn to heroin for the relief they so desperately needed.
In other words, they hit the streets. These weren’t alley-variety addicts though; they were patients. And as such, they were neither schooled in the ways of the streets nor privy to the toxicity of heroin.
Hens in a Foxhouse
What happens when you throw a hen into a foxhouse? All kinds of abominable things, many of them ending in death. When that pain pill spigot was initially turned off, the number of heroin-related overdoses was but a blip compared to those attributable to prescription opioids. Within six years the two were tied. Worse, by then fentanyl had entered the fray, which made it a three-way photo finish.
Three-way ties can’t last forever. By 2017 fentanyl-related overdose deaths doubled those from prescription pills and heroin combined; by 2018 fent-related ODs had beaten both times five.
The rest is history… one of the worst chapters in social history America has ever experienced.
History Repeating: This Time with Adderall
That history isn’t over. The spike in Adderall overdoses makes that perfectly clear.
Make that the spike in fake Adderall overdoses. The DEA says 60% of the counterfeit pills it tests contain a potentially lethal dose of fentanyl. That means Adderall, a favorite – and easily-available – “study drug”, is killing a whole lot of students. And not just college age students either. In fact, junior and senior high school deaths are occurring at an even greater rate.
No wonder, considering Addy’s availability. If a kid can’t get pills via social media or on the dark web, they can easily find it in the corner park. Heck, half the time they can pick up a pill or three in the school restroom.
You didn’t think a few enterprising classmates would neglect such a windfall, did you?
America’s telehealth system can’t be diagnosed in a single sitting, but a September 2022 Watchblog report from the Government Accountability Office (GAO) does provide a rather insightful look into its growth.
Telehealth appointments boomed during COVID, of course, especially among recipients of federal healthcare (Medicaid and Medicare), which rose a respective 15x and 10x their pre-pandemic levels. Telehealth expenditures, naturally, also rose, “increasing from about $306 million to about $3.7 billion” in 12 months.
The CDC released its own report last October, counting all telehealth users (not just federal recipients), and it found 37% of Americans had availed themselves to the practice. Those numbers not only tallied nicely with those provided by the GAO, but they showed America’s telehealth system was growing healthier by the year.
Or was it? Does larger really mean healthier? If so, to what degree and for whom? Crucial questions, to be sure. Unfortunately, at the time neither the GAO nor the CDC had the answers.
Find the Answers
They certainly had some ideas about where to find those answers though. The GAO says telehealth programs are supposed to be monitored by the Centers for Medicare and Medicaid Services (CMS). The GAO also said it found the CMS “does not collect, assess, or report information about the quality of telehealth care given by Medicaid providers.”
Huh? If the CMS is tasked with “monitor[ing] the quality of care provided” by telehealth programs, wouldn’t it stand to reason that they’d “collect, assess, or report information about the quality of telehealth care given by Medicaid providers”?
Of course it does.
The CMS apparently did identify concerns in the quality of Medicare telehealth services, including risks of harm to patients and provision of services that were not medically necessary (for example genetic testing). Yet, despite these concerns, the GAO found the CMS took no further action.
Granted, we’re talking about some 140 million combined patients, which is more than the populations of either France, Germany or Italy. Nevertheless, if the government itself can’t accurately monitor telehealth, how can citizens be sure telehealth is, well, good for their health?
Adderall comes in two flavors: IR (Immediate Release) and XR (Extended Release). GoodRx says Adderall IR “contains the instant-release (IR) forms of dextroamphetamine and amphetamine salts, starts to work within 45 minutes, but only lasts for up to 4 to 6 hours.” Adderall XR, in contrast, “contains the extended-release (XR) forms of dextroamphetamine and amphetamine salts [and a single dose] typically lasts throughout the day.”
Generics cost around $30 a month and have been around for over 20 years. Name brand Adderall sells for around $300 and has been around since 1996. Despite its price though, Addy doesn’t seem to be going away anytime soon. Even if it does, no worries, the company that owns the XR patent also owns four of the 10 generic providers.
That company used to be Richwood Pharmaceuticals. Richwood started hyping its Obetrol diet pill as a remedy for ADHD as early as 1994. In ‘96 the company, now Shire, rebranded it as Adderall. The name, a contraction of the phrase “A.D.D. for All”, was intended to convey that “it was meant to be kind of an inclusive thing” – ya know, for marketing purposes.
It also proved to be a rather prophetic piece of wishful thinking.
The Selling of ADD
Wiki pulled those quotes from Alan Schwarz’s eye-opening New York Times piece “The Selling of Attention Deficit Disorder.” Oh, Schwarz dove deep into the drug’s diabolical marketing alright, and what he uncovered turned out to be even scarier than suspected. But the most frightening part of the piece was what that marketing had unleashed.
At the time, CDC data showed the number of children taking ADD medication had risen from 600,000 to 3.5 million, meaning a full 15% of high school-age children had been diagnosed with the malady.
“The numbers make it look like an epidemic,” said Dr. Keith Conners. “Well, it’s not. It’s preposterous.”
Even more preposterous? Drug industry profits, which had quintupled in 10 years. That salient fact not only alarmed Dr. Conners, even though he’d previously been advocating for wider ADHD diagnosis, but it also riled pharmaceutical exec Roger Griggs, who’d brought Adderall to market in the first place. Stimulants are “nuclear bombs,” he told Schwarz. And they shouldn’t be directly marketed to the general public under any circumstances.
The worst part of all of the above though wasn’t the flipping of advocates (though there was that) or even the obscene profits (though there was that too), it was that Schwarz’s reporting dated back to 2013. So those diagnoses – and profits – have had yet another full decade to rise.
America’s Adderall Problem
And, yes, so have the number of Adderall users and abusers. The generation of opioid addicts that arose as a result of Big Pharma’s egregious greed has been well documented. So has their fate. And so have the personal tragedies. Tragedies, we probably need not add, that have touched basically every American.
That’s what makes the Adderall situation so puzzling. Once again, bad actors have been allowed to prescribe heavily-addictive narcotics with little or no oversight. Once again, such allowance has left America with hundreds of thousands of new addicts. And once again, that new generation of addicts is being forced to the streets after being suddenly denied the medication they so desperately need.
Forgiving types might say this time the problem stems from the onslaught of online prescriber/providers that cropped up during COVID rather than the pill mills of yesteryear. But aren’t they really the same thing? Besides, don’t both prescription writers prescribe medications supplied by Big Pharma? And isn’t prescription oversight handled by the same parties now as it was then?
What about that oversight? The U.S. Food and Drug Administration handles prescription drug advertising. Does that mean the FDA also handles the advertising of online prescription clinics?
A Federal Issue
Yes and no. Yes, the FDA is tasked with tracking online pharmacies. But so are the Drug Enforcement Administration (DEA), the U.S. Department of Justice (DOJ), and the U.S. Department of Health and Human Services (HHS). Those federal agencies “have spent decades trying to disrupt the illegal online pharmacy marketplace,” says the National Association of Boards of Pharmacy. No easy feat when almost everyone is up to no good.
That’s right, the NABP found that “nearly 95% of the websites offering prescription-only drugs online operate illegally.” The organization also found that “89 percent of [the] illegal online pharmacies [it reviewed] did not require a prescription for the sale of prescription-only medicine.” Makes us believe the government is right to sic a hit list of agencies on the issue.
But can the combined efforts of the FDA, DEA, DOJ and HHS fix what ails telehealth? One can only hope so. In the meantime, it’s to everyone’s advantage to check and re-check their medication, wherever it comes from. It also may be to your advantage to check and re-check whether or not you even still need medication.