Challenges in the Global ADHD Medication Supply Chain

Patients and healthcare providers may need to change which type of medication they are using to manage their ADHD to another brand or method.⁶ However, this can pose challenges due to changes in formulation, side effects, regimens, and more.⁶

When patients lose access to their medication, it challenges their ability to adhere to their regimen. How consistently someone uses their medication is known as adherence. Simple dose regimens are associated with ADHD medication adherence, potentially partially because of convenience.15 If regimens are disrupted inconveniently, then adherence may also be impacted, damaging the individual's overall care.

Regulatory and manufacturing obstacles: Why is ADHD medication hard to produce?

Some ADHD medications, like stimulants, are tightly regulated.¹⁶ Regulatory processes may slow down a medication's production and distribution.⁹ Some stimulants used to treat ADHD are controlled substances.^17,18 Controlled substances are medications that are regulated by policymakers, such as the government.¹⁹

Some perspectives suggest that stimulants may be misused and, therefore, should be regulated.¹⁸ However, research suggests that ADHD stimulants lack mechanisms that would be desired for their abuse.¹⁸ Moreover, research suggests that stimulant prescriptions may prevent the misuse of other substances.^20,21

A large-scale study was done using national registers in Sweden to investigate the relationship between the prescription of stimulants for ADHD and substance abuse over a two-year period.²¹ Not only did the data suggest that stimulant prescriptions were not an indicator of an increase in substance abuse, but also that substance abuse rates were 31% lower among those who were prescribed stimulants than those who were not.²¹

The findings of this study could indicate that stimulant use could be a preventative or protective measure when it comes to the misuse of substances.²¹ Moreover, similar findings have been replicated in other research.²⁰ Despite this, alongside the overall safety and effectiveness of stimulants as a treatment, the medication remains strictly regulated.²²

Strategies for managing ADHD medication shortages

The first step that is generally suggested to those who are struggling to access ADHD medication from their usual pharmacy is to contact a different pharmacy to ask if they have medication available.^13,14 If not, patients are advised to work with practitioners to find suitable alternatives.^6,13,14,

Bioequivalent medications are sometimes prescribed to ensure people can continue medication during supply chain shortages.^6,23,24 Some types of medication, including modified-release methylphenidate, may need to be prescribed by brand.^6,24 This is because different brands of medication can have different levels of bioavailability.^6,24

Different formulations across different brands may be why some medications have different levels of bioavailability.⁶ The Medicines and Healthcare Products Regulatory Agency in the UK suggests approaching these changes cautiously, with the practitioner and patient working together closely to manage the transition.⁶ For example, the patient must be made aware of any different side effects or dosages.⁶

Some healthcare systems also suggest refilling repeat prescriptions a set amount of time in advance.¹³ If the medication is out of stock, this allows time for the patient and practitioner to create an action plan and choose what alternative medications need to be accessed. In some healthcare systems, including the UK, practitioners are, however, advised not to refill more than a 30-day supply at once in case this furthers any supply chain issues.²³

What can be done? Addressing the future of ADHD medication availability

The supply chain for pharmaceuticals is complicated and challenging.⁹ Mitigating shortages, inconsistencies in compliance, and technological adaptation all pose challenges to drug procurement, dispensation, distribution, and inventory management.⁹ Strategies being put in place to handle this are crucial for managing difficulties faced across the pharmaceutical and healthcare industries.^9,25

Policymakers, like governments and regulatory bodies, alongside pharmaceutical companies, could all play an instrumental role in managing the availability of ADHD medication. The British Generic Manufacturers Association (BGMA) has noted that medicine shortages in the UK are in part because of a lack of supportive policies for the production of generic drugs.²⁵ This could make the healthcare system less resilient in times of emergency.²⁵

Technological innovation can improve the medication supply chain.⁹ Automotive technologies, including robotics, have been used at various points throughout the history of supply chains with some success.⁹ More recently, researchers have suggested that deep-learning neural networks may offer supply chain advancements.⁹ Large language models could be used to integrate systems for inventories or to automate processes.⁹

Despite the innovation neural networks could offer to the supply chain, there are still many aspects of the challenges faced that they may struggle or fail to address.⁹ The researchers note the networks cannot predict increases in demand or shortages of raw materials, for instance.⁹ Therefore, alternative solutions are also needed to manage the supply chain issue.

References

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2. American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
3. Kamimura-Nishimura, K. I., Brinkman, W. B., & Froehlich, T. E. (2019). Strategies for improving ADHD medication adherence. Current psychiatry, 18(8), 25. https://pmc.ncbi.nlm.nih.gov/articles/PMC8049396/
4. Cunniff, P. J., Ahsan, A., McCrary, C., Dien, T., Kuhn, T. H., Vazifedan, T., & Harrington, J. W. (2024). ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting. BMC psychiatry, 24(1), 188. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05623-4

5. American Society of Health-System Pharmacists (ASHP). (2024). Drugs shortages list. https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=CurrentShortages
6. GOV.UK. (2024). Methylphenidate long-acting (modified-release) preparations: caution if switching between products due to differences in formulations. https://www.gov.uk/drug-safety-update/methylphenidate-long-acting-modified-release-preparations-caution-if-switching-between-products-due-to-differences-in-formulations
7. Newcorn, J. H., Nagy, P., Childress, A. C., Frick, G., Yan, B., & Pliszka, S. (2017). Randomized, double-blind, placebo-controlled acute comparator trials of lisdexamfetamine and extended-release methylphenidate in adolescents with attention-deficit/hyperactivity disorder. CNS drugs, 31, 999-1014. https://pubmed.ncbi.nlm.nih.gov/28980198/
8. Maneeton, N., Maneeton, B., Woottiluk, P., Suttajit, S., Likhitsathian, S., Charnsil, C., & Srisurapanont, M. (2015). Comparative efficacy, acceptability, and tolerability of dexmethylphenidate versus placebo in child and adolescent ADHD: a meta-analysis of randomized controlled trials. Neuropsychiatric disease and treatment, 2943-2952. https://www.dovepress.com/comparative-efficacy-acceptability-and-tolerability-of-dexmethylphenid-peer-reviewed-fulltext-article-NDT#:~:text=According%20to%20this%20review%2C%20d,better%20than%20that%20of%20placebo.
9. Aguero, D., & Nelson, S. D. (2024). The potential application of large language models in pharmaceutical supply chain management. The Journal of Pediatric Pharmacology and Therapeutics, 29(2), 200-205. https://pmc.ncbi.nlm.nih.gov/articles/PMC11001215/
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11. Chan, A. Y., Ma, T. T., Lau, W. C., Ip, P., Coghill, D., Gao, L., ... & Wong, I. C. (2023). Attention-deficit/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study. EClinicalMedicine, 58. https://pubmed.ncbi.nlm.nih.gov/37181411/
12. Gimbach, S., Vogel, D., Fried, R., Faraone, S. V., Banaschewski, T., Buitelaar, J., ... & Ammer, R. (2023). The impact of the COVID-19 pandemic on ADHD medicine consumption in 47 countries and regions. European Neuropsychopharmacology, 73, 24-35. https://pmc.ncbi.nlm.nih.gov/articles/PMC10106831/
13. National Health Service (NHS): South West London and St George's Mental Health NHS Trust. (2024). ADHD medication shortage. https://swlstg.nhs.uk/adhd-medication-shortage/
14. National Health Service (NHS): Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust. (2024). Shortage of medicines for ADHD (Attention Deficit Hyperactivity Disorder). https://www.cntw.nhs.uk/services/adult-adhd-service/shortage-of-medicines-for-attent ion-deficit-hyperactivity-disorderadhd-information-for-patients-families-and-carers/
15. Kamimura-Nishimura, K. I., Brinkman, W. B., & Froehlich, T. E. (2019). Strategies for improving ADHD medication adherence. Current psychiatry, 18(8), 25. https://pmc.ncbi.nlm.nih.gov/articles/PMC8049396/
16. Preuss, C. V., Kalava, A., and K.C. King. "Prescription of controlled substances: benefits and risks." StatPearls. StatPearls Publishing, 2019. 
17. Graf, W. D., Miller, G., & Nagel, S. K. (2014). Addressing the problem of ADHD medication as neuroenhancements. Expert review of neurotherapeutics, 14(5), 569-581. https://pubmed.ncbi.nlm.nih.gov/24738763/