National shortage of ADHD medication: how stigma distorts a genuine disability

Photo Courtesy: Wikimedia Commons

On September 27th, The Department of Health and Social Care issued their safety alert to patients with Attention Deficit Hyperactivity Disorder (ADHD) across the country, warning that the supply of medications had been disrupted by manufacturing issues and increasing global demand. Prescribers of the medications listed in the alert have been told to avoid starting newly diagnosed patients on a prescription. There is currently no clear date for when the medications will be back in stock, with some suggestions hinting at early 2024 at the earliest for some medications. 

This has led to patients with existing prescriptions to start rationing their medications, fearing what may occur if they cannot make their prescriptions last until the end of the shortage. 

What are the current shortages?

ADHD is a psychiatric condition that impedes an individual's ability to function and perform tasks on a daily basis. It is typically assessed using the Diagnostic and Statistical Manual 5th edition (DSM–V) criteria. For a diagnosis to be confirmed, 6 or more symptoms relating to hyperactivity and impulsiveness must be recorded. It is important to note that a diagnosis can occur in adulthood but requires evidence that symptoms have been present since childhood. 

The shortage has affected a variety of ADHD medications, including Atomoxetine, which works by inhibiting the reuptake of neurotransmitters e.g., noradrenaline. By blocking the reuptake of the molecule, the activity within the brain increases as the nerve endings do not try to take up the remaining transmitters. 

In functional aspects, patients will suffer from multiple complications if they have any interruption to their treatment. Some can have a partial recurrence of symptoms, where only some tasks e.g., concentrating on a long task at hand will be difficult,  others may be more severely affected, finding themselves unable to do basic tasks. Individuals with the condition may already struggle with the social aspect of their lives but, increased anxiety is linked to not being able to take essential medication, preventing them from going about their daily activities.  

How is the condition wrongly represented?  

Owing to how the condition presents within patients, stigma is an unfortunate certainty. Whilst patient and family education effectively provides good quality care for those affected, scepticism towards the individual’s behaviours and reliance on medications is common among people who have not received such education.  

Stigma is characterised as a strong feeling of disapproval towards an individual, arising from misconceptions or misinformation about the circumstances. Those who are diagnosed with ADHD are often met with the “ADHD is not a real condition” line, viewed as simply misbehaving or seeking attention. A study from 2019 suggested that the symptoms affected individuals portray makes them come across as “impolite” or “unreliable” in their day-to-day behaviour. 

ADHD UK estimates a total of 2.6 million people live with the condition, including nearly 700,000 children. In Scotland, new figures suggest that there are as many adults now receiving treatment as children, owing to later diagnosis in life. As people are slowly being identified later on in life, worries turn to how they may be perceived within the workplace, with some worrying that their livelihoods and jobs might be at risk. 

Individuals now face a prolonged period of time without their medications. This is not a condition that is treatable with therapy or non-pharmacological interventions, they need their medications to live their lives. The medication shortage will exacerbate issues that were otherwise treated by their prescriptions. The struggle they experience is real. Most of the audience for the piece will be unaware of the number of students in their cohort or even their immediate social circle that have the condition. Everyone needs to do their part to read about the condition, understand it and fight the negative connotations the condition carries with it. 

Writers’ Note: I was brought to this topic by one of the wonderful editors who is a part of the Pi Media team. If you are facing the issues mentioned above, please speak to your General Practitioner as soon as possible. Whilst medications are in short supply, your local practice might be able to offer additional services to assist during this period of time.