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  • Writer's pictureJulie Love

Stimulant Shortage

Think of a medication you take – when did you last fill the prescription? What do you need to do to get a refill? When will you go pick it up? For most people and most meds the answers to these questions would be “I don’t know or care exactly when I last got it, I don’t have to do anything (it’s on auto refill, or I get a 90 day supply), or I just call the pharmacy for the next refill, and I can pick it up whenever it’s convenient for me to do so.”

But for others, it’s not that simple. They need to know when they last picked it up, because they need a freshly issued prescription every month, and have just a two-day window to pick it up.

What happens if the pharmacy doesn’t have it in stock? Normal meds: if you can wait, they’ll let you know (and since you may have picked up previous month’s over a week early, you have enough to last). If you can’t wait, they’ll just transfer it to a different pharmacy for you.

But for stimulants, if the pharmacy doesn’t have it in stock, they won’t accept the prescription from you even if you could wait. And they can’t transfer it to another pharmacy; you must take it there yourself. If the prescription was sent electronically, you have to call your prescriber to cancel it and re-submit it to the other pharmacy. Except you don’t know what pharmacy might have it in stock, and if you call to ask, they won’t tell you. They expect the prescriber to call instead (so you have to also tell your NP/MD which pharmacies you can get to, and hope they will have time to sit on hold for 20-30 min for each one). And this whole process can’t even start until you are just two days away from running out. If you were busy and didn’t go to pick it up until the day you’re out… uh-oh

Take that dysfunctional system – for treatment of an issue that impacts executive functioning – and now add in a nationwide shortage. Millions of people can’t get the medication they need to take every day.

But at least there’s abundant sympathy and compassion. Oh wait – no there isn’t. There’s some awareness – but mostly of the opinion that it’s the clients’ fault, because ADHD meds are so “overprescribed.” (Prescriptions have increased since the pandemic. Turns out once parents were supervising their child’s remote learning, a lot of them finally saw and believed the issues the school had pointed out before. And while many people seem to think adult tasks require no sustained attention, more and more adults are realizing that their daily struggles aren’t a character flaw but actually a diagnosable and treatable neurological issue. Unfortunately, increased awareness of a need can lead to increased profiteering, which draws all patients into a web of suspicion.)

If you have ADHD, you face a pervasive attitude that you don’t really need the medicine, unless you’re some kind of failure. Any number of people (friends, family, doctors, insurance carriers) are all too eager to tell you so. Especially now that you’re struggling with the stress of not being able to get it. If you’re a kid, it’s probably that you’re lazy and/or your parents don’t know how to discipline you properly; if you’re an adult… well, you must be a drug addict. Just try to find an article about the current shortage that doesn’t immediately segue into talking about drug abuse, diversion, and withdrawal. And when they do discuss the people who take their prescribed medication, as prescribed, to treat their diagnosed ADHD, they oh-so-helpfully say the meds are just like glasses – unless you’re seriously impaired, you can still see without them, just not as well. Even if this were true – do you really want me driving a car?

Most of the people panicking over not being able to fill their stimulant medication prescriptions are not addicts. They are not desperate to get high, or afraid of withdrawal. If they have been taking it consistently, abruptly stopping can result in some discomfort, but what they are really concerned about is the return of their symptoms. Of going back to being the kid always in trouble in class. Of it taking twice as long to accomplish half as much. Of failing tests, failing classes. Of screwing up at work. Of losing their job. Of increased arguments. Of needing to work so damn hard to try to just stay on track. Of crashing their car. Literally.

We all feel busy and stressed about holding it all together. It’s like we’re all jugglers doing that plate-spinning trick. It’s actually a good analogy, because most actual plate spinners have plates designed to stay on the stick and keep spinning – they look flat, but they’re really slightly cone-shaped. Having ADHD is like doing that same trick with perfectly flat plates. When you find a medication that works, it’s like it puts at least a small dent in the plate for you. Yes, everyone else is also working very hard and demonstrating skill keeping their plates in motion, no doubt, but some people actually need extra skill to do what only looks like the same trick. Meds helped make life challenging rather than overwhelming, but suddenly the universe is throwing them back into trying to keep up when they have plates that are simply harder to spin. It would be nice if people were a bit more compassionate.

So, what can you do? Notice when the stereotypes start flying and speak up, or at least don’t join in. If you’re talking to an adult with ADHD or the parent of a child with it, show some sympathy instead of minimizing the problem. If you want to help them, ask how first.

Also be kind to your students. Kind does not mean eliminating all expectations. (Far too many kids absorb “Well, I didn’t take my med, so I can’t be held responsible for anything” – a belief that is both appealing and deeply insulting.) Recognize that they will have to work harder, and probably achieve less, while deserving praise for their hard work. If a kid with a broken leg takes forever to get down the hall, you don’t scold their tardiness, but praise their effort. And you don’t ban their assistive devices – so support their access to other supportive ADHD strategies (fidget tools, reduced distractions, movement breaks, organizational systems, prompts, and routines).

It’s similar to what you do when a student has missed their med (not a surprising situation, given the complex gauntlet to refill it each month). Don’t drag them down to the nurse to complain about it (incredibly rude, and pointless that late in the day), and don’t decide that the child can’t be taught (ironically teaching them that they can’t learn). That tells them you don’t want them in your class, you only want their med there.

Kids with ADHD get this message all the time. The medication is just one tool of many – but the fact that it might be an essential tool can often make it seem like the only tool. Everything else – the skills, the effort, and yes, the startling advantages neurodiversity sometimes offers – doesn’t exist. You, as a valued, special, worthwhile person, don’t exist. As the adults around them scramble to navigate this current supply crisis, that soul-crushing message can get really loud. (Yesterday’s client: “Grandma wants me to tell you to check my brain because I forget things.”)

Try to help give kids a different message.

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