{"id":1542,"date":"2023-04-07T12:31:30","date_gmt":"2023-04-07T12:31:30","guid":{"rendered":"https:\/\/news.psva.org\/?p=1542"},"modified":"2023-04-10T18:00:20","modified_gmt":"2023-04-10T18:00:20","slug":"as-adderall-shortage-continues-dea-plans-to-limit-some-telemedicine-prescriptions","status":"publish","type":"post","link":"https:\/\/news.psva.org\/?p=1542","title":{"rendered":"As Adderall shortage continues, DEA plans to limit some telemedicine prescriptions<\/strong>"},"content":{"rendered":"\n
Dr. Beatty quoted in Capital News Service story<\/em>. Reprinted with permission<\/em>.<\/h5>\n\n\n\n

By Ryan Nadeau<\/strong>
Capital News Service<\/em><\/p>\n\n\n\n

RICHMOND, Va. – Jessee Perry was able to get her Adderall prescriptions filled at her small Church Hill pharmacy until two weeks ago, she said. What Perry had only heard through online chatter, friends and family suddenly became far more personal.<\/p>\n\n\n\n

Perry, owner of a Farmers Insurance agency, was diagnosed with attention-deficit\/hyperactivity disorder in 2013, she said. She started taking Adderall in 2016 for ADHD, and apart from a brief period during the COVID-19 pandemic, has taken it continuously. <\/p>\n\n\n\n

Her clients depend on her to keep up with and pay attention to their needs, Perry said.<\/p>\n\n\n\n

\u201cThose are all things that end up getting impacted any time that I have been off of that Adderall,\u201d she said.<\/p>\n\n\n\n

Perry struggles when unmedicated with everyday obligations such as cleaning her home, cooking and being present with others, she said. <\/p>\n\n\n\n

\u201cSomething that might take somebody without ADHD five minutes with no thought on it, these are things that we\u2019re really struggling and fighting with,\u201d Perry said. \u201cIt might take me hours to get it done without my medication.\u201d<\/p>\n\n\n\n

Entering fifth month of nationwide shortage<\/strong>
The Food and Drug Administration added Adderall to its drug shortage website<\/a> in October 2022. Five of the eight listed drug manufacturers still report partial or complete shortages. <\/p>\n\n\n\n

This is not the nation\u2019s first Adderall shortage. The FDA announced a similar shortage in 2011<\/a>, and some of the same concerns raised now were raised then.<\/p>\n\n\n\n

Doctors and patients alike are now finding other stimulant medications are in shortage<\/a> too, according to the American Society of Health-System Pharmacists.<\/p>\n\n\n\n

Dr. Kara Beatty, president of the Psychiatric Society of Virginia<\/a> and practicing psychiatrist in Richmond, has coped with this shortage alongside her patients.<\/p>\n\n\n\n

Beatty spoke with a Capital News Service reporter<\/a> in November 2022, one month after the shortage began. Beatty said, at that time, she felt the nation was only \u201con the fringes\u201d of this shortage.<\/p>\n\n\n\n

\u201cNow, we are getting hit so hard,\u201d Beatty said. \u201cSpecifically January and February, which traditionally tend to be difficult months for individuals \u2014 it\u2019s become so much more difficult this year.\u201d <\/p>\n\n\n\n

More than just new patients are affected by this shortage, Beatty said. Existing patients, like Perry, are now also struggling to get their prescriptions filled.<\/p>\n\n\n\n

\u201cSo many of my patients that are on Adderall or other stimulants that have a confirmed diagnosis of ADHD, have been on these medications for a long time, are no longer able to get them,\u201d Beatty said. <\/p>\n\n\n\n

Regulating<\/b> controlled substances in the age of telehealth<\/strong>
Beatty owns the small practice Resilience Health<\/a>, where she offers a \u201chybrid model\u201d to her patients, she said. Beatty schedules both in-person visits and televisits depending on patient needs, as it creates more flexibility for everyone involved, she said.<\/p>\n\n\n\n

The U.S. Drug Enforcement Administration designates Adderall and other stimulant medications as Schedule II drugs, according to its website<\/a>. <\/p>\n\n\n\n

That designation comes with many regulations in Virginia<\/a>, including a six-month expiration date, a no refill policy, prescription tracking and strict guidelines for partial dispensing. <\/p>\n\n\n\n

Schedule II prescriptions also cannot be transferred between pharmacies without a paper prescription, meaning patients searching for their medication at other pharmacies have to come back into the office for a new one, Beatty said. She usually sends all prescriptions electronically, but the shortage has made that much harder, she said.<\/p>\n\n\n\n

The use of telemedicine spiked during the COVID-19 pandemic. Rates have since stabilized, but use of telemedicine in 2021 remained 38 times higher<\/a> than pre-pandemic levels, according to a study by the consulting firm McKinsey & Company.<\/p>\n\n\n\n

Adderall prescription rates increased during this same period, especially for adults aged 22-44<\/a>, according to Trilliant Health. <\/p>\n\n\n\n

COVID-19 lockdowns and isolation forced many to reflect more deeply on their mental health, Beatty said.<\/p>\n\n\n\n

\u201cWe all just formed better relationships with ourselves and gave ourselves some compassion,\u201d Beatty said. \u201cSo, I think that\u2019s a big piece of it.\u201d<\/p>\n\n\n\n

The DEA released its proposed permanent guidelines<\/a> for future telemedicine operations late last month.<\/p>\n\n\n\n

Patients would need to have an in-person visit with their medical practitioner before they can receive a prescription for any controlled medication<\/a>, including for ADHD treatment.<\/p>\n\n\n\n

\u201cDEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm,\u201d stated DEA administrator Anne Milgram in the press release.<\/p>\n\n\n\n

The public has until March 31 to submit comments on the DEA proposals. These comments will be considered by the DEA in the final draft, according to the release.<\/p>\n\n\n\n

New Resilience Health patients are already required to schedule an in-person visit, Beatty said.<\/p>\n\n\n\n

\u201cEthically, as a physician, I am a firm believer in in-person visits,\u201d Beatty said. \u201cI think telehealth has its benefits, so I created a hybrid model.\u201d<\/p>\n\n\n\n

Patients utilized telemedicine during the COVID-19 pandemic and beyond it to access health care remotely. Physicians also saw the benefit of remote health care, Beatty said.<\/p>\n\n\n\n

\u201cI think a lot of people [physicians] are gonna be in trouble, because a lot of people have given up their office leases,\u201d Beatty said. \u201cA lot of practitioners do not see people in-person, and I think it\u2019s gonna be very challenging.\u201d<\/p>\n\n\n\n

Beatty spends only two days a week in-office, she said. It creates a \u201cjigsaw puzzle\u201d to schedule all patients prescribed a controlled substance into those two days. <\/p>\n\n\n\n

Shortage cause remains unclear and ‘complex’<\/strong>
Telemedicine alone cannot be blamed for the shortage, Beatty said.<\/p>\n\n\n\n

\u201cIn reality, it\u2019s so complex,\u201d Beatty said.<\/p>\n\n\n\n

The root cause of the shortage is difficult to identify, but Perry said some of it has to do with education and new access to the care needed to get medication. Social media has helped people become more aware of ADHD symptoms, she said. And women, she said, have been \u201chistorically\u201d underdiagnosed with ADHD.<\/p>\n\n\n\n

\u201cFemales don’t show the same symptoms and signs as our male cohorts, who tend to be more hyperactive, and it gets caught at a young age,\u201d Beatty said. <\/p>\n\n\n\n

There is a stigma associated with stimulant medication that Perry said leads people to think it is being abused.<\/p>\n\n\n\n

\u201cThat people are abusing these medications and people are being overdiagnosed, but ignoring the fact that maybe we\u2019ve been underdiagnosing a lot of different marginalized populations,\u201d Perry said.<\/p>\n\n\n\n

More Adderall prescriptions were dispensed than there were individuals with a formal ADHD diagnosis, according to a Trilliant Health study<\/a>. The discrepancy could indicate patients were using a direct-to-consumer platform with a self-pay option, rather than insurance, it stated. <\/p>\n\n\n\n

Drug abuse is always something to consider with controlled substances, but Beatty trusts the many regulations in place to prevent it, she said. The Prescription Monitoring Program<\/a>, which came out of the opioid epidemic, is one of many systems in place to help curb drug abuse, she said.<\/p>\n\n\n\n

Beatty has not seen any data indicating drug abuse is a factor driving the shortage, but hesitates to rule anything out at this time, she said.<\/p>\n\n\n\n

\u201cNo matter whose fault \u2026 people are suffering,\u201d Beatty said. \u201cWhen I see that my patients are struggling to work \u2014 I don\u2019t know why our society would want this. This is really detrimental to peoples\u2019 wellbeing.\u201d<\/p>\n\n\n\n

Finding a solution appears equally complicated<\/strong>
U.S. House Rep. Abigail Spanberger, D-Va., last December urged leadership across the country to respond in force to the shortage.<\/p>\n\n\n\n

\u201cPatients who rely on Adderall to function daily deserve a comprehensive federal response to ensure access to their medications,\u201d Spanberger stated in a press release<\/a>. \u201cGiven the complicated regulatory framework around controlled substances and the incentives in the drug industry, addressing the shortage of Adderall will require coordination between FDA, DEA and industry.\u201d<\/p>\n\n\n\n

Perry is prescribed both short and extended-release Adderall to manage her ADHD symptoms, she said. She is currently rationing what stock she has left, after multiple pharmacy searches have come up short.<\/p>\n\n\n\n

\u201cThis is getting really bad,\u201d Perry stated in a follow-up email. <\/p>\n\n\n\n

The struggles are not simply a lack of focus, or not listening, she said. <\/p>\n\n\n\n

\u201cThese are things that are absolutely essential daily tasks that we\u2019re trying to get done,\u201d Perry said. \u201cWe just aren\u2019t able to do them in an effective manner at all unless we\u2019re medicated.\u201d<\/p>\n\n\n\n

Capital News Service is a program of Virginia Commonwealth University\u2019s Robertson School of Media and Culture. Students in the program provide state government coverage for a variety of media outlets in Virginia.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Beatty quoted in Capital News Service story. Reprinted with permission. By Ryan NadeauCapital News Service RICHMOND, Va. – Jessee Perry was able to get her Adderall prescriptions filled at her small Church Hill pharmacy until two weeks ago, she said. 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