TAMPA — Robbin Tenea calls it a game of musical pharmacies, one that has her driving all over town to fill her two children's prescriptions for Adderall to treat their attention deficit hyperactivity disorder.
"It's extremely frustrating," Tenea said.
And it's a game that's likely being played by many people, due to a national shortage of the drug at a time when some say it's needed most — the final weeks of school before winter break.
"When I have a kid with ADHD, and he's not able to get his medicine, that's a problem," said Dr. Michael Bengtson, a pediatric and adolescent psychiatrist and associate professor at the University of South Florida. "I've been dealing with several families where this is an issue."
What's causing the shortage? Manufacturers of the generic, immediate-release form of the drug — which is the most popular form — blame increased demand and a limited supply of the drug's active ingredient, amphetamine, which is controlled by the federal Drug Enforcement Administration.
(There's no shortage of name-brand Adderall, but it's only available in extended-release form.)
Doctors blame the shortage of generic Adderall (which is also known as mixed amphetamine salts) on the fact that more kids and adults are being diagnosed with ADHD. Estimates for ADHD patients range from 5 million to 15 million, with the number increasing about 5 percent a year.
But others say it's also because more people than ever are abusing the drug, including students who use it to stay awake and cram for tests.
Another category of abuse: If an addict can't get oxycodone, Adderall is viewed by some as a reasonable alternative, said Dan Fucarino, owner of Carrollwood Pharmacy.
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Tenea said she first noticed the Adderall shortage three or four months ago. At first, pharmacies were out of the 30-milligram pills. But then they started to run short of other types as well.
"I would go to CVS, Walgreens, Sweetbay and Publix," Tenea said. "I keep the prescriptions in the car, and whenever I pass one I go to see if they have it."
Since Adderall is a controlled substance, many pharmacies will not tell her over the phone if they have it in stock, she said.
Tenea has a 10-year-old son and a 17-year-old daughter. At one point, when she couldn't fill a prescription for one of them, she would dip into the other's supply. So far, she hasn't run out entirely.
Bengtson told of a family that couldn't get Adderall for their son, and he got a D on a test.
"I can't tell you for certain that's why he got a D, but that's what families are telling me," Bengtson said.
Poor grades can be particularly frustrating for a child with ADHD, who then takes his or her anger out on the parents. "There are several different repercussions," Bengtson said.
Doctors fear legitimate patients are being hurt by an increase in Adderall abuse, especially on college campuses.
Dr. Lee J. Dorpfeld, a licensed mental health counselor and coordinator for the Center for Addiction & Substance Abuse at USF, said he's seeing an increase in Adderall usage by students who don't have ADHD. Some take it recreationally, others reserve it for finals.
Where do they get it? From students who have an ADHD diagnosis, he said.
Fucarino, the owner of Carrollwood Pharmacy, said he has noticed more people coming into his pharmacy asking for the drug, but he reserves his limited supply for established patients — a practice he has also used for prescription painkillers.
With some new patients, he said, "it's hard to figure out who is legit and who isn't."
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Why don't pharmaceutical firms just make more Adderall?
Manufacturers often make drugs in large batches, in some cases enough to fulfill the expected demand for two to three years, Fucarino said. Then machines are retooled to make another drug, a process that can take several months.
Adderall, which has a high potential for abuse, poses another complication since the federal government controls how much amphetamine manufacturers can have.
It's not known when the shortage is expected to ease.
Meanwhile, patients, doctors and pharmacists are scrambling for alternatives.
Mike DeAngelis, a spokesman for CVS, said that when a medication is not available, pharmacists often work with physicians to find another one.
One option is the extended-release, name-brand version of Adderall, which is not in short supply. But it is more expensive, and its effect is not the same as the fast-acting variety.
Or the patient can be moved to another ADHD drug such as Dexedrine or Ritalin, though these may work differently or not at all.
"Some respond to one product, but not others," Bengtson said.
Richard Martin can be reached at firstname.lastname@example.org or (813) 226-3322.