FDA Commissioner Blames Adderall Shortage on Stimulant Overuse, Telehealth, Generics
The increase in ADHD diagnoses and stimulant medication prescriptions by telehealth providers are partially to blame for the ongoing Adderall shortage, according to the commissioner of the Food and Drug Administration, who also cited “a large amount” of unnecessary stimulant use by patients with ADHD.
4 Comments: FDA Commissioner Blames Adderall Shortage on Stimulant Overuse, Telehealth, Generics
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It is unfortunate that the interviewer did not challenge Dr. Califf on the sources of his (mis)information, from where did he come up with those conclusions? The same “standards of evidence” used to assess quality of evidence in clinical practices should be applied to any statement by a governmental health official – Grade A = consistent, good-quality evidence; Grade B = inconsistent or limited-quality; Grade C = consensus, usual practice, expert opinion. Califf’s “evidence” rates Grade F by those standards – no factual evidence to support his statements, information that contradicts his statements easily obtained (Google Scholar for instance), no attempt to acknowledge that he was expressing personal opinion and had no professional knowledge of the condition at issue nor its treatment. The DEA is even worse, without any knowledge of the nature of medical practice much less treatments of disorders/diseases they are regulating the amounts of medications that can be made to treat a common disabling condition using biased information and statistics.
Regarding standards of care for ADHD, there are evidence-based algorithms and guidelines for diagnosis and for treatments; In the US those have been drawn up and published by the AAP for children and AACAP for teens. Canada has had guidelines for diagnosis and treatment of ADHD in adults for over 10 years, first developed and published by the Canadian ADD Resource Alliance (CADDRA), a non-profit multidisciplinary professional organization. First edition published in 2006, 4th edition in 2018.
Applying the various guidelines in clinical practice is the tricky part. Evidence-based information about a multitude of conditions is published all the time, but not used in practice, for a variety of reasons. An “evaluation” on Zoom done in under half an hour which results in a prescription for Adderall does not meet any standard of care for ADHD. Telemedicine has a valid place in medical care, if anything especially in the care of mental health conditions, BUT…a diagnostic evaluation for mental health disorder needs to be done in person. This is one thing the DEA has right, in-person evaluation before any Controlled Substance prescribed (at least Class II and III); probably not a bad idea to apply it to prescribing anti-psychotics either.
A medical or nursing degree unfortunately does not prevent any more bias and prejudice against the diagnosis (or even existence of) ADHD, misconceptions about stimulants, and skepticism that it is a disabling condition. Everything and anything we can do to get accurate facts out to clinicians and the general public is worth it.
It’s just a perpetuation of existing stereotypes in the medical community. A cardiologist who used to work at Google is not an expert in ADHD diagnosis and treatment. I pray for the day our issues are taken seriously.
Califf is just plain dangerous. We do need better standards of care for ADHD, but I don’t think he said that out of a desire to actually help us. I think his version of “standards of care” would be restrictive and would end up prohibiting the use of medication by those who really need it.
The statements made by Commissioner Califf are disappointing and naive. The continued placement of blame on telehealth for the challenges across ADHD is a misconception that distracts from us facing the real problem head-on. Our internal data shows there is little difference in symptoms across settings and models of care. What telehealth has done is significantly increase access to care for millions of people in the U.S. that otherwise wouldn’t have sought the help they needed.
Dr. Califf’s call for better standards of care for ADHD is critical. The need for standardization of care is long overdue in the U.S. and must include evidence-based, objective measures. Incorporating technology-driven tools into the ADHD diagnosis and management processes can alleviate the significant backlog many providers are experiencing and ensure that the right patients are receiving the best care.
ADHD is the most common and most treatable mental health condition, it’s imperative that we work to expand and improve the quality of care for individuals affected by the disorder and not limit it.