The global shortage of medications used to treat attention deficit hyperactivity disorder is having “significant repercussions” in the UAE, doctors have told The National.
“In the UAE, the impact is seen in both educational and healthcare settings,” said Dr Suresh Wadhwani, a consultant psychiatrist at Lighthouse Arabia in Dubai.
“Children and adults with ADHD are experiencing difficulties managing their symptoms due to inconsistent medication availability. This can lead to challenges in academic performance, workplace productivity and daily functioning.”
The shortage is expected to persist throughout the rest of the year, added Dr Wadhwani.
“Long-term solutions, such as diversifying supply chains, creating medication reserves and developing new treatments, are being considered, though they may take years to fully stabilise the situation.
“Experts predict some relief by late 2024, but systemic changes will be necessary for a complete resolution.”
Supplies dwindle
There are several reasons why the supplies of ADHD medications – including brand names such as Concerta, Ritalin, Adderall, Stratox and Elvanse or Vyvanse – are dwindling across the world.
For a start, the number of people being diagnosed with ADHD has skyrocketed over the past few years.
ADHD is a neurodevelopmental condition categorised by three types: hyperactive and impulsive; inattentive; and a combination of the two.
Key symptoms of the hyperactive subset include being unable to sit still, poor concentration and excessive talking and movement.
Signs of the inattentive form of the condition include short attention spans, appearing forgetful and struggling to stick to time-consuming tasks and follow instructions.
The number of people aged 23 to 49 receiving a formal ADHD diagnosis from 2020 to 2022 has almost doubled, according to the 2023 report by Epic Research.
Experts largely agree the reasons for the increase include the Covid-19 pandemic, as people were less able to manage their symptoms, as well as the proliferation of telehealth services and rising awareness, prompted by social media.
As the number of diagnoses increase, so does the demand for medications, but these are predominantly subject to regulations in the US, where they are produced and where several controlled ingredients are allocated to drugmakers in limited quantities, making it difficult for manufacturers to keep up with demand.
“While demand for ADHD medications has surged, regulatory bodies have been slow to adjust these quotas due to concerns about misuse and diversion,” said Dr Wadhwani.
“This tight regulation, though important, has limited the availability of these drugs.”
Dr Valentina Faia, a specialist psychiatrist and medical director at the Free Spirit Collective, said up to a third of her patients at the City Walk clinic have been affected by the shortage.
“This is largely due to the scarcity of alternative generic producers and also due to the addictive potential of these drugs, which is an issue that is rightly closely monitored in the UAE,” she said.
In the UAE, Concerta and Ritalin, which are both made from the same active ingredient, methylphenidate, are in particularly short supply, she added.
The National reached out to the major pharmacy chains in the UAE for comment on the shortage. Some individual branches confirmed that they were out of stock of prescription medication for ADHD and could not say when the next delivery would be.
'Angry and frustrated'
Dubai resident, Jane O'Neill, 45, who works in the PR industry, has been taking the non-stimulant atomoxetine (Stratox) for about 18 months and said she has been unable to find any pharmacy with stock in recent weeks.
Each time she gets a new prescription, she has to ring around several different pharmacies across Dubai and Abu Dhabi to find anywhere with any left.
“The thing with ADHD is motivation and calling people and being organised are things we struggle with, so it can be really difficult.”
In the meantime, Ms O'Neill's doctor has prescribed an alternative medication called Wellbutrin, an antidepressant used off-label for ADHD, but which is also often in short supply.
“It’s not agreeing with me very much, though. I have insomnia, no appetite, dry mouth and it’s not doing what I need it to,” she said. “I really hope more becomes available soon.”
Gemma White, a mother of three and writer who contributes to The National, said her nine-year-old son has been affected. He has been taking the lowest dosage of Concerta for a year.
“He is able to focus so much better at school, sit still without constant fidgeting and it has vastly improved his ability to socialise with his peers,” she said.
Before the summer holidays, the family had had to travel to Abu Dhabi from their home in Dubai to fill prescriptions, but when they returned for the new school year, they contacted 10 pharmacies to find somewhere that had the medication and they were all out of stock.
“We finally located one bottle, which we only got because it had been turned down by someone else who needed a different dose level.”
As a result, they have begun to ration the medication, giving it to her son only from Monday to Thursday. “It has already been noted by his teachers and teaching assistants how different his behaviour and ability to focus on a Friday is compared to the rest of the week, which is negatively impacting his education.
“It has changed his life and now it is being taken away from him which we are very angry and frustrated about.”
Dr Teizeem Dhanji, a consultant child and adolescent psychiatrist at Sage Clinics in Dubai, said it is important that pupils receive help from schools, particularly as those starting the new term struggle to settle in.
“It’s important to meet with the school to think about accommodations that can be made to support children,” she said.
“Such as movement breaks, extra time in exams, one-to-one support or practical changes within the classroom environment."
Job loss and examination struggles
Earlier this year, ADHD UK found that 6 per cent of the 2,000 ADHD sufferers who responded to a recent survey reported they had lost their jobs because of a medication shortage.
Dr Faia said adult patients, when unmedicated, often struggle with procrastination and low productivity in the workplace.
“This is due to a fundamental divergence from the norm in the way dopamine is transported and absorbed in ADHD brains, providing significantly less motivation to do work that the patient does not find enthralling,” she said.
In schools, where in some cases as much as five to 10 per cent of the population suffers from ADHD, the shortage of medication has done more “substantial damage”, she added.
“ADHD children who have been prescribed medication oftentimes are simply unable to follow classes and learn properly without these drugs," Dr Faia said.
“The critical period in brain plasticity found within school-age children is being wasted as a result of these shortages, in a way that risks doing permanent harm to the quality of education that ADHD children receive.”
What to do if you can’t find medication
When a patient is unable to access their ADHD medication, the first step is to consult with their prescribing doctor to assess the situation and explore alternative options, said Dr Wadhwani.
They may prescribe a different, more accessible medication or discuss a temporary discontinuation plan. Non-pharmacological interventions such as behavioural therapy, executive coaching or lifestyle changes, including structured routines, exercise and mindfulness, may also be recommended, he added.
“Continuous communication between the patient and healthcare provider is crucial to managing ADHD symptoms effectively during the shortage,” said Dr Wadhwani.
