The ADHD Rx shortage is impacting children and their families. Here, a clinician shares how she supports her patients.
How is the ADHD medication shortage impacting your patients, and what can you do to best support patients and their families during this medication crisis?
Psychiatric Times chatted with Rachel Petersen-Nguyen, MD, who shared her thoughts and insights. Petersen-Nguyen is a faculty trainer with the Reach Institute and a clinician and medical director of the primary care outpatient clinic at Children’s Minnesota in St. Paul.
“Patients with ADHD and their families sometimes face barriers to their medical care, and this medication shortage has increased the number of barriers that they are facing.
“The way it seems to be working now—and this is for the last year—is different medications in ADHD stimulant classes have had shortages. I will write a prescription and the family will go try to fill the prescription, and sometimes the pharmacy has it available, and now some have them more consistently. Some of the medications have more consistently had shortages. So the [family will] get to the pharmacy and find out it's not available. This leads to sometimes a number of back and forth messages or phone calls for us to help find a medication that is covered by their insurance and is available at the pharmacy and is appropriate to treat their ADHD.
“This is making it more difficult for families who are already facing barriers to medical care. Choice is always to make a switch within the stimulant class of medications, if that's what they're already on. And thankfully, there are a number of different formulations… And so we'll try a different stimulant or a different formulation, if that's possible. Sometimes patients have already tried the other types or the other formulations and they just have this one stimulant that's been working well for them. And if that is in shortage, then we need to start thinking other directions.
“And we have options of other medications, like non-stimulant medicines. So sometimes we have to think about those really hard, especially for families that have found a medicine that just working really well for their child. Making a switch sometimes is smooth. Sometimes it's just a little bit shorter acting, and they might need another medication to help at the end of the day. Or sometimes it's a little longer acting, and we need to just follow up and make sure that they don't develop any problems with sleep or other side effects. However, if they have new side effects, we may have to switch to the other type of stimulant medicine.
“It takes a lot of communication. For families, it takes a lot of persistence. And for us on the provider side, it takes a lot of patience and persistence helping them to find the next option. What else might we try that will help with their symptoms and not cause significant side effects? This needs to be a team effort. Some families are really on top of this, and start calling various pharmacies [to see] what pharmacy has [the medication] available. Some families, many families that I work with, struggle because of language barriers or transportation problems... And so we also want to help in any way we can.
“ADHD is multimodal, so that means that medicine is not the only thing that helps for kids. although. medicine is a main part and it's a really big part. It's key in their treatments, but there are other things that help. School supports—making sure the school is aware of the type of help that the child might need because of ADHD. And then that can be formalized with a 504 plan or an IEP; or just being really open and communicating as much as possible to help the child to have their teachers know or their school health officials like a school nurse know about it.
“We are fortunate to have integrated behavioral health in our clinic at Children's. And so I have therapists right there every day that can help talk with a family about therapy strategies to help with ADHD, and then also offer therapy resources in the community. Like I said about the medication and access, [there are] problems for therapy, for many of our patients… we are finding barriers these days due to long wait time.
“If ADHD symptoms are not well treated, this can really be demoralizing for kids, and adolescents, and families. If they are also experiencing an anxiety disorder or depressive disorder, then we want to make sure we maximize the treatment for that. So that may be medication and maybe therapy, and ideally a combination of both of those things. And for children really struggling with those ADHD symptoms, we want to maximize treatment if they can get access to their medication. But if they're really having trouble accessing it for a time, maximizing those nonpharmacologic things as well as in the treatment for co-occurring conditions can be really, really important and helpful.
“I think knowing what is evidence based [is very important] in helping our patients, especially as they face medication shortages: what are other medications that have good evidence to be helpful? And what therapies that will be helpful? I feel like in my initial learning with the Reach Institute about 12 years ago, and then all the work I've gotten to do with the Reach Institute since then, I've learned more and more and gained more confidence… in what will be helpful for my patients. And that just gives me more confidence as I talk with them about the importance of talking with the school or accessing therapy in addition to taking their medications.”