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    Where's My Ritalin?

    Dr. Patricia Quinn

    Our guest blogger is Patricia O. Quinn, MD, a developmental pediatrician specializing in the treatment of ADHD in both children and adults.

    Over the past weeks I have been contacted by several individuals who either have ADHD themselves or are the parents of children and teens with ADHD. Their primary complaint is that they cannot refill the prescription medication used for the treatment of their ADHD symptoms.  One mother reported that she had been to 13 pharmacies in her home and surrounding towns to refill her son’s Adderall XR.

    According to a recent Washington Post article, it seems that the current problem with drug shortages appears to be one of distribution as well as production.

    The overriding problem in this situation, however, is not simply cost or convenience, but rather that one stimulant can not readily be substituted for another. When someone has ADHD it can take several weeks, and sometimes even months, for a physician to determine the correct type (class) of medication, dose and treatment schedule to effectively reduce that patient’s ADHD symptoms while at the same time limiting potential side effects. Doses and delivery systems vary (time-released beads verses patches versus another type of pill called osmotic push compartments, for example) with each medication. In addition, each medication is effective for a distinct time period in each patient calling for differing and individualized dosage schedules. This may mean that you may be without your medication for some time.

    When stimulant medications are discontinued for whatever reason, ADHD symptoms return quickly.  With these symptoms come major problems in day-to-day functioning affecting an individual’s performance on the job, in school, and at home…not to mention safety. With an increase in risk-taking behaviors, lack of attention and distractibility come distracted driving, speeding tickets, and accidents. Relationships and individuals suffer. Most parents of children and teens and adults with ADHD are panicked at the thought of going back to their old ways of trying to get through each day — and you can’t blame them.

    While we are waiting for this problem to be resolved, if you can’t get your medication, there are several things you can do to try to get by until your medication is available again.

    1.    Substituting like-for-like is the best alternative. If a generic version of your medication is available try that first (Example: methylphenidate for Ritalin).  Talk to your physician about trying the short-acting version of the same medication you are on, but take it more frequently (Example: Adderall for Adderall XR rather than Concerta for Adderall XR).

    2.    Let people know that you are not able to take your medication and ask for their help and understanding.  (Parents, be sure to send a note to school to inform your child’s teacher and ask for help).

    3.    Give yourself more time to accomplish a task.
    This might mean getting up earlier in the morning or asking for an extension on an assignment.

    4.    If you tend to act impulsively, put off making an important decision until you are back on your medication or at the very least sleep on it overnight.

    5.    Use tools to keep on task. Set an alarm and check that you are doing what you are suppose to be doing. Ask for more supervision or have someone check in with you more frequently.

    6.    Do the hardest tasks first or earlier in the morning when you are not as tired. Also look for quiet, distraction-free spaces to work.

    7.    Get plenty of rest and exercise. Exercise can decrease hyperactivity and that feeling of restlessness.

    8.    Take frequent breaks. Get up and walk around and come back to a task after a few minutes to refocus.

    9.    Try to keep to the same routine.

    10.    Make lists and use lots of reminders. Send yourself an email or voice mail or write on your hand if you need to.

    11.    If driving is a problem, ask someone else for a ride or take public transportation.

    12.     Forgive yourself and ask others to be more patient with you.
    Don’t make excuses, but do make a sincere effort to avoid problem situations or discussions that you know may get out of hand.

    13.    Don’t forget to eat.
    Often when people get distracted, they tend to skip meals and this can only add to problem behaviors.

    14.    Start your medication again as soon as it is available. Remember, however, that if you have been off your medication for some time that it may take days to get back to functioning where you were before you stopped taking it.

    15.    Plan ahead and keep a few pills in reserve for the next time that there is a shortage!

    While this problem affects each of us with ADHD, there is little we can do about it except write to the drug manufacturers and those in Congress letting them know that this issue is a serious matter for all involved — patients, parents, physicians, spouses, employers, and school systems.


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