This newsletter includes information regarding the national shortage of Adderall, how long it is estimated to last, and alternative options for your patients.
We also discuss whether medicinal cannabis has benefits or risks for psychiatric disorders, key points from a presentation on natural medications in child and adolescent psychiatry, and our practical research summaries of adult and child and adolescent psychiatry (Quick Takes and CAP Smart Takes).
National Shortage of Adderall
On October 12, 2022, the FDA announced a shortage of the immediate-release formulation of amphetamine mixed salts, known as Adderall IR.
- What is the reason behind the shortage?
- The largest producer is experiencing ongoing intermittent manufacturing delays. Other manufacturers cannot produce sufficient supply to meet U.S. market demand.
- What are the consequences of this shortage?
- This shortage started in the summer but has now become a significant problem. Now, pharmacies are unable to fill patient orders. Some patients have stopped taking their medication in the last month, which has consequences for their functionality.
- Does this shortage affect all Adderall doses and formulations?
- No, some tablet formulations are available, whereas others are not. The FDA posted a list of current and resolved drug shortages and discontinuations, which were classified by manufacturer and doses. You can review the list here.
- How can we help our patients during this shortage?
- Switch temporarily to an extended-release formulation or another brand.
- Consider another amphetamine product that is not in high demand.
- Consider other stimulants, such as Ritalin, or nonstimulant options, such as guanfacine.
- Any changes should be made after evaluating the patient’s medical history.
- What are the risks of switching to another medication or brand?
- Unfortunately, not all brands or medications are covered by insurance.
- Some patients might have to pay more.
- Not all available drugs are ideal as an alternative for certain patients.
- Patients may respond differently, and titrating and finding the best dose for a patient may take a while.
- How long will the shortage of Adderall last?
- The FDA’s estimated supply recovery dates range from late October 2022 to March 2023. You can read more here.
Medicinal Cannabis and the Psychiatric Patient: Clinical Harm vs Novel Treatment, With Diana Martinez, M.D.
In this interview, Dr. Diana Martinez discusses current research on the use of cannabis for various conditions, such as pain, depressive and anxiety disorders, and residual symptoms of schizophrenia, among others. She also highlights the importance of discussing with patients the health risks associated with cannabis use.
Interview highlights include the following:
- Approximately 1.5% of cannabis users have a heart attack.
- Patients who use cannabis should be advised to take symptoms of chest pain or pressure seriously and get medical help should these occur.
- Patients at risk for suicide must be asked about symptoms of depression as well as possible drug use, including cannabis use.
- Cannabis use can increase impulsivity and the risk for completed suicide.
Learn more and earn 0.5 CME credits here.
Natural Medications in Child and Adolescent Psychiatry
In this presentation, Dr. David Rosenberg discusses the use of complementary and alternative medicines (CAMs) in children and adolescents. He reviews the available evidence and potential indications of the most used CAMs in children with mental health conditions, such as melatonin, ginkgo biloba, ginseng, and St. John’s wort. Finally, he provides a clinical vignette to elucidate the use of CAM therapies in clinical practice.
Use of Ginkgo Biloba in Children and Adolescents
- Ginkgo biloba is effective in reducing ADHD symptoms.
- Although ginkgo biloba is less effective than MPH for ADHD treatment, it can be effective as adjunctive therapy.
- Side effects of ginkgo biloba are generally mild.
- Avoid using ginkgo biloba simultaneously with anticoagulants and in individuals with blood clotting impairments.
- Adding ginkgo biloba may provide additional benefits for patients who are taking MPH and have a partial response.
Learn more and earn 1.25 CME credits here.
Quick Takes: Research, Digested
Antidepressants and Vertebral and Hip Risk Fracture
- Antidepressants are associated with an increase in the risk of hip and vertebral fractures.
- The effect size is large in this review of 11 studies, but in at least some populations, the absolute risk increase is small. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
CAP Smart Takes: Research, Digested
Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders
- Risk of substance use and substance use disorders in childhood-onset psychiatric disorders:
- The use of pharmacotherapy for childhood-onset psychiatric disorders does not increase the risk.
- Treating childhood-onset psychiatric disorders may significantly reduce the risk.
- In ADHD patients with a comorbid substance use disorder, nonstimulant alternatives are often preferable to avoid increased risk. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
Remember that if you become a Silver or Gold member, you can listen to all of our content on your favorite podcasting app with our exclusive audio feed.
References
- Federal Drug Administration. (2022, October 12). FDA announces shortage of Adderall. FDA. https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall
