ADHD medication shortage hits Canberrans hard with GPs forced to 'cobble together' prescriptions
Harriet Torres had just celebrated her 42nd birthday when she was diagnosed with attention deficit hyperactivity disorder (ADHD) in 2022.
As her psychiatrist revealed the diagnosis, she burst into tears.
"It was a great relief after what had been a lifetime of not quite understanding myself,"Ms Torrens said.
"I kind of knew going in that I was probably going to get a diagnosis, but to have someone actually confirm that was really a powerful thing.
"It turned off a negative voice in my head that had been there my whole life, so it was almost instant."
Ms Torrens, an administrator at the Australian National University, was prescribed medication to help her manage her ADHD traits, which included hyperactivity, inattention and impulsivity.
Concerta helped Harriet Torrens manage her ADHD traits for more than two years, but she had to swap to another medication when an increased dose was unavailable. (ABC News: Adam Kennedy)
The drug — a long-acting stimulant called Concerta — had an almost immediate impact.
"It's important to highlight that medication is only one tool, but it has been a very useful tool for me," she said.
"I have both hyperactive and inattentive ADHD, which is tricky, but medication allows me to structure my day and my thoughts better.
"It gives me the ability to cut through and get things done."
For more than two years, it worked beautifully.
Then in February, Ms Torrens's psychiatrist recommended increasing her dose, only for her to find the dosage had become unavailable.
Australia has been in the grips of an ADHD medication shortage since late last year, with the Therapeutic Goods Administration warning it is likely to persist until at least the end of this year.
Harriet Torrens says the medication she is on now requires taking a number of tablets throughout the day. (ABC News: Adam Kennedy)
'Expensive' and 'difficult' workarounds
The causes of the shortages are complex, with manufacturing and supply chain issues playing a part as well as increased demand for the medications across the globe.
Concerta, Ritalin and Teva XR are in the shortest supply in Australia, with Rubifen expected to join that list next month.
Thankfully for Ms Torrens, her general practitioner Laura Chapman had a few options to choose from.
"In Harriet's case, because I have prescribing rights, I was able to rotate her medication,"Dr Chapman said.
She first tried mixing two drugs that had not been impacted by the shortage, but the side effects were problematic, with Ms Torrens slipping quickly into "a real depression".
A shift to another drug has been much more effective, though it involves Ms Torrens taking a number of tablets across the day rather than one first thing in the morning.
Laura Chapman says many of her patients have told her they are phoning multiple pharmacies to fill their prescriptions and still coming up short. (ABC News: Adam Kennedy)
"It has changed my whole routine and it's more expensive, so it's been quite difficult," Ms Torrens said.
Dr Chapman said Ms Torrens's experience was becoming increasingly common, with many of her patients reportedly phoning multiple pharmacies to fill their prescriptions and coming up short.
The shortage has had somewhat of a cascading effect, with drugs becoming harder to get as more people switch their prescriptions from one to another.
Dr Chapman said she felt frustrated at being forced to "cobble together" prescriptions to come up with a mix of available drugs to help her "distressed" patients simply function.
"Harriet's pathway is a really good example of cobbling together,"she said.
"By that I mean we often need to pivot a person's pharmacological treatment to agents that are different and therefore not ideal.
"So, taking a bit of creative license, which is not always in the patient's best interest."
Laura Chapman says people with ADHD often struggle with executive dysfunction. (ABC News: Rosie King)
Dr Chapman said often the solution was more expensive and involved the patient taking a smaller dose of medication multiple times a day, like in Ms Torrens's case.
She said that was particularly onerous for people with ADHD who typically struggle to manage their executive function.
And even then, Dr Chapman said she could not promise there would not be a shortage of the new drugs she prescribed.
"Being in that situation where I can't make guarantees and people are feeling really, really anxious with no solution is pretty soul-destroying,"she said.
Families struggling
General paediatrician Kim Bland said the impact the drug shortage was having on families in Canberra was "heartbreaking", with some parents going without entirely or making compromises like rationing doses to their children.
"They'll give their child medication on Monday, Tuesday and Wednesday and hope they've got enough learning on those days that they can go without their medication on Thursday and Friday," Dr Bland said.
Kim Bland says the drug shortage was seeing some parents ration doses to their children or go without entirely. (ABC News: Adam Kennedy)
"There are families not giving it in school holidays and on weekends when they normally would, and mums and dads are taking the brunt of that challenge with executive function, memory, focus and emotional regulation because they want to prioritise their child being able to regulate at school.
"It's really, really heartbreaking to hear some of the things parents are doing and going through."
Dr Bland said she had spoken to parents who had called every pharmacy in the ACT as well as those in towns over the border in New South Wales to find medications, with little luck.
"Some of my families have just worked their way through the first shortage, transitioned to a new medication, only to be told that's going into shortage as well," she said.
"So, they really have nowhere else to go — I'm worried many of them have just given up because there's no options left for them."
Kim Bland would like to see more medications made in Australia. (ABC News: Adam Kennedy)
For children with ADHD, being unmedicated can have a serious impact on their ability to learn and retain information and lead to significant emotional dysregulation.
Dr Bland said if left untreated over a long period, it could cause such significant disengagement with school that a child's education would suffer long-term.
'Hunger Games effect'
She said the "free market" was partly to blame, with medications ultimately going to the country willing to pay the most for them.
"It would be nice to see more incentives from the federal government to make our market more lucrative,"Dr Bland said.
"But also, only 10 per cent of our medications are made in Australia, and that makes us very vulnerable.
"It's quite a long-term dream, but I would really like to see some kind of buffer where some of these medications could be made here."
Simon Blacker says some pharmacies are buying extra ADHD medications to ensure supply, meaning others go without. (ABC News: Adam Kennedy)
In pharmacies across Canberra, a Hunger Games-style battle to secure what stock is available has developed.
ACT Pharmacy Guild branch president and community pharmacist Simon Blacker said ongoing drug shortages since the pandemic had led to a habit of pharmacies buying as much as they could safely store when medications were in stock.
"I know personally of pharmacies that are buying more drug safes just so they can store more ADHD medications when they become available,"Mr Blacker said.
"That obviously means other pharmacies and patients are missing out, and that's the unintended consequence of drug shortages — and we wish it didn't happen, but it's a challenging time.
"It's often described as a Hunger Games effect, but we are in a global economy."
Harriet Torrens says she was very fortunate to have an accessible GP who could adjust her prescription. (ABC News: Rosie King)
As for Ms Torrens, her new mix of medications is proving effective — and, perhaps just as importantly, available for now.
But it was not lost on her how different her experience could have been.
"I am very fortunate because I have an excellent GP, who I have access to pretty readily," Ms Torrens said.
"The minute I wrote her an email, she was onto it, but I'm really aware that not everyone is in that situation.
"I was also fortunate to have just had an appointment with my psychiatrist, and she had given my GP a lot of scope to support me with adjustments to my prescription.
"If you're waiting months and months to get in to see a psychiatrist, what do you do?"