Keystone Pharmacy fields as many as 30 calls a day from people trying to fill their Adderall prescriptions.

But there is a national shortage of the drug commonly prescribed for children and adults to treat attention deficit disorders.

“For a lot of people, it’s the only thing that helps them function through the day,” said David Miller, co-owner of Keystone, 4021 Cascade Road SE. “They are pretty desperate.”

Adderall is one of more than 200 prescription drug shortages this year, according to Food and Drug Association.
That already surpasses 2010, when the drug shortage list peaked at 178.

In 2005, there were only 61 drugs in short supply.

“It’s a real challenge for pharmacists across the state,” said Larry Wagenknecht, chief executive of the Lansing-based Michigan Pharmacists Association and a licensed pharmacist. “It’s the worst I’ve seen in 30 years.”

The most common shortages are for drugs given in a hospital setting. Those include cancer drugs, anesthetics used for patients undergoing surgery, drugs for emergency medicine and electrolytes needed for patients on IV feeding.

View full size Although the shortage of Adderall and similar drugs have focused national attention on the problem, 74 percent of the drugs in short supply are for cancer treatment, said Charles Mollien, a clinical pharmacist for health care provider Priority Health.

“For the majority of the cases, this is life and death,” Mollien said.

Spectrum Health, West Michigan’s biggest hospital system, has not delayed any treatments because of drug shortages, but it is a big problem, said Spectrum Health spokesman Bruce Rossman.

“Every hospital in Grand Rapids, every hospital in Michigan, every hospital in the country has been dealing with drug shortages on and off for the past year,” Rossman said. “Unfortunately, it’s becoming a weekly, sometimes daily occurrence here.”

The hospital has become adept at working around the problem, but it is labor intensive.

Pharmacists, physicians and staffers now sometimes have to meet several times a day to discuss alternative medication plans for patients. Switching medications used for treatments requires changing everything from staff protocols to ordering procedures.

Saint Mary’s Health Care is checking its normal supply channels several times a day for the drugs in short supply to place orders or back orders, and is working directly with manufacturers when possible, said Terry Kirkpatrick, the hospital’s director of pharmacy services.

“So far, we’re continuing to meet the needs of the patients who have trusted us to fill their prescriptions,” Kirkpatrick said. “It is taking a lot more time for our buyers and a lot of work with physicians for flexibility, but we’re making it work.”

Saint Mary’s also is working with neighboring hospitals to borrow and share when possible, he added.

Cause and side effects

Besides complicating patient treatment and care, the shortage is blamed for driving up health care costs.

The drug shortage is an example of what happens when the law of supply-and-demand collides with the urgent needs of health care.

“It’s very painful because people’s lives are impacted,” Miller said. “We aren’t talking about a car you can’t get.”

The shortage of medication for IV feeding is just one example of a growing drug shortage that is adding to the cost of health care. Last month, President Barack Obama ordered the FDA to take some steps to reduce drug shortages. Those include pushing drug companies to quickly report shortages so they can be addressed, speeding up reviews of new manufacturing facilities and working with the Justice Department to step up investigation of price gouging in the pharmaceuticals market.

While the industry supports the increased federal oversight, some blame the problem on a federal law that gives the FDA and Drug Enforcement Agency the power to limit the amount of “controlled substance” ingredients available for manufacturing.

The DEA oversight is intended to prevent ingredients or drugs from being sold on the black market for recreational use.

Adderall, a class of stimulant drugs, was widely prescribed as a diet pill until two decades ago, when the practice was banned. It is now classified by the DEA as Substance II, the same legal category as cocaine and heroin, because it can be lethal.

On the black market, the drug dubbed kiddie cocaine is bought by high school and college students as a study aid because it helps with concentration.

Limiting materials needed for drugs may no longer be the best solution in the black market fight. Mollien noted that ingredients and drugs now can be electronically tracked from factory to pharmacy shelf.

For those who can find Adderall, the price has climbed 400 percent in the past 6 months. It now costs $120 for 90 20-miligram tablets, Miller said. The price has gone up so quickly that insurance reimbursement contracts don’t reflect the true costs.

“When we can get Adderall, we can lose $40 to $50 on a prescription,” Miller said. “We can’t afford to lose those kind of margins every time we fill prescriptions.”

In most cases, pharmacists work with doctors to find alternative drug treatments for patients. In the case of Adderall, doctors can often prescribe Ritalin or Vyvanse, or their generic versions depending on the patient.

Replacing drugs with similar medications has been a short-term solution in some cases, because it has led to shortages of other drugs, Miller said.

Retailers also affected
Pharmacy Technician Angela Mendenhall prepares sterile products used as IV medications at the Meijer Heart Center. At the retail level, most of the drugs impacted by the shortages are the cheaper, generic versions of costly drugs that aren’t as profitable for companies to produce.

Retailers from Walker-based Meijer Inc. to drug store chains including Walgreens and Rite Aid have been hit by the shortages as well.

Traditionally, drug shortages occur at the end of the year when manufacturers have exhausted their supply of ingredients. Production for Adderall is expected to begin again in January but it isn’t expected to be readily available until March because of the testing required.

One reason there isn’t a quick fix for the shortages is that the problem is complex, said Laurie Wesolowicz, director of pharmacy services clinical for Blue Cross Blue Shield of Michigan.

“I don’t think it is really clear at this point (and) that is why the (Obama) administration has told the FDA to hire more people to look at why there are these shortages,” she said. “I think there are so many factors that go into the shortage. It certainly is going to be financial and there are some regulatory requirement issues and there aren’t lot of manufacturers making these drugs. So, if one has an issue, that can totally impact the availability of a drug in the market.”

Pharmacists are supportive of the steps Obama has taken to reduce the shortages but warn the results will take time.
“It will take years to fix this,” Mollien said.