Emma* says she was made to feel “like a drug addict” for simply trying to access medication for her ADHD.
When she was prescribed Vyvanse in June, she was relieved to realise she had found a treatment that would make it easier to live with the developmental disorder that affects the brain’s executive functioning.
When she was first diagnosed in 2022 at the age of 41, the initial prescription of Ritalin alleviated some symptoms, but it also made her feel anxious.
However, Emma’s “magic month of feeling great” on Vyvanse came to an end when she sought to get the prescription renewed, only to find that numerous pharmacies were out of stock.
After visiting and calling more than 15 stores over five hours, she went home empty-handed having been through “the most dehumanising medical experience” of her life.
Her search provoked suspicion from pharmacists because Vyvanse is a stimulant, subject to strict prescribing and dispensing regulations due to the drug sometimes being abused and used for recreational purposes.
“I was made to feel like a drug addict – I wonder if anyone would treat people that need medication for other chronic conditions like diabetes or heart disease in the same way?”
Emma says the psychiatrist who prescribed her Vyvanse did not mention there was an ongoing global shortage owing to a worldwide spike in demand. The medication has not been in regular supply in Australia for more than a year.
The medicines regulator, the Therapeutics Goods Administration (TGA), announced the shortages of 30mg, 40mg, 50mg and 60mg strengths experienced last year had been resolved in April this year, only for shortages to be declared again on 14 June for 20mg and 60mg doses.
A spokesperson for the TGA said the shortages were due to manufacturing issues across almost all strengths of the product. Subsequently, “the 20mg strength experienced increased demand due to patients switching to it because of unavailability of other strengths”.
Finally finding a medicine that worked well for her, only to learn there was no certainty around access to it, “feels quite cruel”, Emma said.
Without it, she said, she would struggle to be as productive and to find relief from feeling at times overloaded and burned out.
Dr Karuppiah Jagadheesan, chair of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP’s) ADHD network, said the shortage was concerning, especially because there were no alternatives. The drug was available in Australia from only one company, Takeda, which manufactured it in the US.
It was first listed on the Pharmaceutical Benefits Scheme for children diagnosed with ADHD in 2015, and then expanded to those diagnosed as adults in January 2021. Since then prescriptions have nearly doubled, with 623,611 in 2021 and 1,384,302 in 2023, according to the TGA.
after newsletter promotion
A spokesperson for Takeda said that in addition to the previous shortages and increased demand, its ability to replenish stock had been limited because the complexity of the manufacturing process – utilising an active pharmaceutical ingredient that was registered as a controlled substance – was highly regulated.
The company said it utilised the full quota of the medicine it was allotted by the US Drug Enforcement Administration (DEA).
Jagadheesan said both Ritalin and Vyvanse were efficacious medicines but it was difficult for psychiatrists to know which patients would respond better to.
RANZCP has sought a meeting with the DEA to discuss fast-tracking the supply of Vyvanse, as well as increasing Australia’s quota , but the DEA rejected the plea.
Takeda’s patent for Vyvanse expired in the US in August last year and other companies are making alternatives such as Adderall XR. Jagadheesan said these need to be approved in Australia.
The TGA spokesperson said: “While the TGA is not responsible for coordinating the supply of medicines in Australia, it takes medicine shortages very seriously and works with pharmaceutical companies (known as sponsors) to help minimise the effects on patients.”
The shortage of Vyvanse 20mg was expected to be resolved by 21 August, the spokesperson said. “Takeda anticipates that by this date, sufficient stock will be available to meet normal demand across all major pharmaceutical wholesalers.”
The 20mg Emma takes is the lowest dose of Vyvanse available. The advice many pharmacists gave her was to get a prescription for a higher dose that is not in shortage.
Jagadheesan said it was “absolutely dangerous” for people with ADHD to be switching doses, but that the pharmacists’ advice might have been referring to an alternative method of being able to take a 20mg dose from the 40mg capsule.
While capsules couldn’t be split in half like a tablet, there was a method of mixing the capsule in water and drinking half for each dose, Jagadheesan said. However, that should be explained to patients, he added.
A spokesperson for the Pharmacy Guild of Australia said: “The guild agrees that patients shouldn’t have to shop around for their essential medicines.
“Manufacturers, wholesalers and government have a role to play in ensuring sufficient stock is available in Australia so that patients can get their essential medicines when and where they need them.”
* First name only used to protect medical information