16 ms·

Drug shortages have worsened and may only increase in the future, experts say

139 points by orhmeh09 3y ago

dumpsterlid 3y ago
[dead]
hinkley 3y ago
We need to stop offering tax deductions for advertising and offer tax deductions for maintaining inventory. We are squeezing all of the safety margins out of our entire economy because that's what the beancounters tell us to do.
- StreetChief 3y ago
  Because that's how the rich get richer
  - hinkley 3y ago
    Because the thing that makes them an extra 5% is what will be done. If we reward people 5% for cutting to the bone, they will, every time. See also perverse incentives. For medical supplies there should be a specific tax exemption for maintaining emergency supplies. Or a law, or both.
    - hammyhavoc 3y ago
      You'd get my vote.
    - jjeaff 3y ago
      No deduction. Just a law. If you want the regulatory privilege of providing important medications to the public, you must be able to continue to provide said medications during supply issues for national security purposes.
      - MichaelZuo 3y ago
        A law enacted with what votes?
      - hinkley 3y ago
        So that would have to be something contingent on FDA approval for your factory? I could see that. I would also expand that to include any drugs that require a tapering off period should require an emergency supply as well. We can't have people keeling over from methadone withdrawals because you decided to piss off your only vendor. In fact I might go so far as to say that you can't institute a price hike without a grace period either, which may or may not include one final prescription renewal at the old price.
        devilbunny 3y ago
        Price hikes got a bad rap because of a few egregious examples, but they've been responsible for shortages, too. I'm an anesthesiologist. Almost all of our drugs are generic. But there have been shortages of one or another for most of the last 15 years. Why? Among other things, the federal government limited price hikes to a percentage per quarter that Medicare and Medicaid would pay (gross oversimplification, but close enough). This sounds like a great idea. But when you can't do a 100% price hike on a drug that sells for 40 cents per ampule, you can't pay overtime and do increased-tempo maintenance to keep a line running almost 24/7. So if one generic manufacturer quits making a drug that only has 2-3 sources, the others simply can't fill in the gap. Sometimes they stop making it because it's no longer profitable, sometimes because other factors (failing to pass an inspection, e.g.) cause a temporary shutdown. But if you can't double the price of a dirt-cheap drug, you often can't double your output (because the drug is cheap - it's the labor, packaging, and regulatory compliance that are expensive, and they scale per dose, not per kg made). This is a very different world from the famous cases you see in newspapers about huge increases in price for medications that have been generic for a long time, but it is there and it really does hit us.
        youainti 3y ago
        As an economist, thanks for using a proper price/shortage example.
- jws 3y ago
  Maybe we should take a page from farm subsidies and have pharmaceutical subsidies where the government will buy some quantity of expired inventory of important medicines. Price it at kind of the low end of what insurance companies would pay the pharmaceutical company, so they'd rather sell it to a consumer, but they can still make money on the government planned over supply.
- refurb 3y ago
  The drugs that have shortages are almost always generics. Those companies don't advertise, they run on razor thin margins - which is exactly why you have shortages because these companies will often just stop making a drug if it's not profitable.
stuaxo 3y ago
Someone going to start asking an LLM the right questions to work out how to DIY these ?
- moonchrome 3y ago
  If it's as accurate as it is for coding good luck with mustard gasing yourself.
- orangepurple 3y ago
  Total Synthesis by Strike
- ftxbro 3y ago
  It's illegal. Not that it would stop everyone, but a lot of people who DIY won't go there. They will do other projects. And if they are going to illegally DIY drugs to make money then they will make other ones instead.
bugglebeetle 3y ago
Since most drugs are the product of public research that then gets gobbled up and privatized by the pharmaceutical industry, we should just build out state capacity for their manufacture. Taking this one step further, we could even had a national healthcare system that monitors utilization and adjusts production accordingly!
- deleted 3y ago
  [deleted]
- jbm 3y ago
  Pre-Corona-destabilization, and pre-Trump, I wouldn't agree with you, but I do now; especially since we are in the middle of the Opioid crisis. The government can and will seize patents at will. Only a handful of people need to be "convinced" to share their knowledge on production, and there are enough laws and spying that anyone can be "convinced". If a hard left president of the US decided the US wanted to produce drugs, it would produce drugs and that would be the end of it. If children start dying because of drug shortages, this will happen.
  - mensetmanusman 3y ago
    Coming from the materials technology arena, those solutions wouldn’t have been available day one if it came out of a government led lab. Government research has no means to pay for the extra effort and talent required to get things done quickly. Also, committee led research can float off into random areas with little applicability this century.
  - tstrimple 3y ago
    > If a hard left president of the US Well that’s never going to happen.
- version_five 3y ago
  > Taking this one step further, we could even had a national healthcare system that monitors utilization and adjusts production accordingly! Yes I've heard that centrally planned economies are great at delivering goods.
whalesalad 3y ago
It took me 6 months to get back to a decent baseline after quitting Adderall cold turkey but I am really glad I did. I hate being dependent on a drug with limited access for survival. In all honesty it is truly no different than being an alcoholic or a crack addict. Virtually every interaction you ever have with a psychiatrist or pharmacist surrounding these meds is fraught with bullshit. It is easier, less stressful and arguably more dignified buy illegal drugs on the black market. Covid was a sobering event for me and it made me realize just how fragile our global economy / supply chain are. I want to be able to exist and survive even in a total collapse (which, tinfoil hat be damned is becoming a more and more realistic possibility). Step 1 was giving up the amphetamine salts.
- soderfoo 3y ago
  I have been plagued by issue after issue with getting my prescription filled correctly (dosage, timing, and shortages). I would prefer to come off of it completely, but my doctor has even managed to make that difficult. Any tips for just going cold turkey? I can't wait any longer for my psychiatrist to prescribe an alternative.
  - TechBro8615 3y ago
    Not cold turkey, but if you can, taper off it. Then just be prepared to deal with groggy, slow, angry mood for three weeks.
    - chasd00 3y ago
      If you’re talking about adhd drugs like adderall then how do you deal with untreated adhd? It’s absolutely exhausting to me and maddening to everyone around me when I have to go without for whatever reason.
      - TechBro8615 3y ago
        I don't, that's why I keep taking them... but I've had periods of time where I lived abroad or didn't have easy access to the medication, so I had to taper off it. It definitely sucks, and especially after you stop using it, you'll feel especially slow and groggy. You'll also gain a lot of weight. But after a few months you'll feel pretty "normal," at the cost of having all your ADHD symptoms return.
motohagiography 3y ago
Drug manufacturing is a solved problem. There are no drug shortages, only pharma FUD.
- alistairSH 3y ago
  Care to elaborate? Supply problems don’t strike me as FUD, but market failures. They might be correctable, with the correct incentives, but they’re still a problem.
  - oatmeal1 3y ago
    US healthcare is about as far away from a free market as there is.
    - alistairSH 3y ago
      I never claimed otherwise.
  - renewiltord 3y ago
    Cut the FDA requirement and drug patents and I will get you higher quality drugs manufactured with full supply chain provenance for cheaper. The biggest secret is that getting on the good side of the FDA is about knowing people and all that usual shit. Americans choose shortages because they think bureaucracy gets them quality. Instead what it gets them is a lack of baby formula and military planes importing it from Europe (presumably only the few cans that would cause children to not instantaneously drop dead like they do in Europe where they don't put FDA labels on them).
- herbst 3y ago
  My small pharmacy here in Switzerland is cooking their own dextroamphetamine and it's cheaper than street prices. There is no shortage, just weird regulation issues
breput 3y ago
FDA drug approval should include a clause that requires a certain production rate per quarter along with an ongoing adjustment based on the number of prescriptions. If the applicant misses the production rate for one quarter, they agree to work with a second source drug producer to prepare for production. If they miss the next quarter's quota, the second source is allowed to sell the drug for no less than three years.
- refurb 3y ago
  It takes a long time to move production facilities. Even if the original company decides to move production to another facility, it can take 6-12 months to run test batches, tests and submit it all to the FDA for approval. I’m not sure drug companies need much incentive to not have supply issues. That’s lost sales. If you dig into the actual causes it’s usually because of DEA limits (Adderal) or massive off-label use (Wegovy) or the fact that the drug is generic and the margins as so small nobody is all that interested in selling it.
Scoundreller 3y ago
> Drug shortages and the quality problems that often cause them aren't limited to generic products, as evidenced by ongoing shortages of Adderall, Wegovy, Pluvicto, and others. These aren't very good examples. 2 of those are relatively new drugs, 1 with runaway demand (Wegovy has the same ingredient as Ozempic) and the other, Pluvicto is a radiopharmaceutical with a short shelf life (so any manufacturing problems have immediate effects). DEA regulations regulate how much amphetamine can be manufactured for production of Adderall, along with 30 day script limits, so there's not going to be a lot of slack in the distribution system, nor in patient's pill bottles.
- Waterluvian 3y ago
  > 30 day script limits Oh so it’s not just Canada that does silly stuff like this. My doctor has to remember to write “300 pills dispensed 60 at a time” rather than “5 repeats” or else I have to go waste his time for refills.
  - Auracle 3y ago
    At least in Minnesota, my doctor can’t even do that. I need to contact him every time. I take three different controlled substances, one needs to be refilled monthly and the others are somewhere between 1-3 months each. It’s a mess and I feel like I’m bugging him every time. They’re busy enough without BS like that bogging them down.
monksy 3y ago
So the short end of the stick is that leaders that are in charge of the cateogries are asleep at the wheel and no one wants to point them out?
chroma 3y ago
The adderall shortage is because the DEA sets quotas on how much can be made per year. Despite increased prescriptions, the amounts produced have remained the same.[1][2] The Wegovy shortage is because it was recently approved to treat obesity. The number of new prescriptions was larger than Novo Nordisk predicted, so they're still ramping up production. 1. https://www.federalregister.gov/documents/2021/12/02/2021-26227/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment https://www.federalregister.gov/documents/2021/12/02/2021-26... 2. https://www.federalregister.gov/documents/2022/12/02/2022-26351/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment https://www.federalregister.gov/documents/2022/12/02/2022-26...
- kileywm 3y ago
  Very interesting document; however, the text seems to disagree with your adderall explanation. https://www.federalregister.gov/d/2022-26351/p-16 https://www.federalregister.gov/d/2022-26351/p-16 > According to DEA's data, manufacturers have not fully utilized the APQ for amphetamine in support of domestic manufacturing, reserve stocks, and export requirements for the past three calendar years 2020, 2021 and 2022. > Based on this trend, DEA has not implemented an increase to the APQ for amphetamine at this time. Which suggests that the DEA's quota for adderall is not (yet) to blame.
  - heyoni 3y ago
    > The majority of the manufacturers contacted by DEA and/or FDA have responded that they currently have sufficient quota to meet their contracted production quantities for legitimate patient medical needs. “The majority” “legitimate patient medical needs” sounds like a bunch of trippy legalese. If it’s the majority of the manufacturers they contacted, doesn’t that mean that there’s at least one that has exhausted their production? Could that one perhaps be the largest one, like Teva? If that’s the case, then yes, there could be a shortage. And they’re not increasing it because there’s been a surge of “illegitimate” shops that have popped up and prescribed remotely since Covid that the DEA is investigating and/or shutting down. And that may not even be the real reason. Could be the understaffing issues quoted in august. Either way, that answer from the register is a non-answer.
deleted 3y ago
[deleted]
euroderf 3y ago
"sole-source suppliers, a concentrated market" Congratulations, America. You have re-created the Soviet economy. All of the problems of centralized planning & production, and with none of the benefits.
xyzzy_plugh 3y ago
The comments in this thread regarding illegal or casual use of adderall or other amphetamines without an underlying condition are really disheartening. In the USA it is already excessively difficult for those suffering from ADHD to get a diagnosis, find medication that works and maintain a ready supply without a buffer. Abusers are contributing to the environment worsening for those who need these drugs. These drugs can literally save lives from chaos and tragic ends. If these drugs help you live a more normal life, you are not an addict or an abuser. The cosmic tragedy here is that this type of medication is practically impossible to become dependent on if you have ADHD. If anything the problem is usually remembering to even take the medication. I fear that abuse will hamstring any efforts to lift production limits.
- Dma54rhs 3y ago
  It's very easy to get a prescription for ADHD meds in the USA, that is why Americans often struggle when they go abroad to Europe or other places to find doctors willing to prescribe them.
  - junofan 3y ago
    The comment was talking about production limits. It is very hard to get a prescription filled.
- SeanAnderson 3y ago
  Hey. I'd love to talk to you more about this if you're willing? I have to assume your comment is in reference to my post. I apologize for saying something that upset you - it certainly was not my intent. My perspective on this is: - The process for getting prescribed Adderall is not objective. One is allowed to see multiple specialists and continue searching until one's perspective is seen and respected. Yes, there are objective differences in the brain, but brain scans aren't being used as the basis for issuing prescriptions. - Adderall, like all drugs, comes with a set of benefits and drawbacks. It's up to the user to decide if those are resulting in a net positive and they are allowed to change their mind at any time. So, it's reasonable to believe that someone who is undiagnosed may still either be, or believe they are, benefiting from the drug - and then change their mind later. Changing their mind does not mean that they retroactively become an abuser. - I would like a source for "practically impossible to become dependent if you have ADHD." There are plenty of studies that show addiction does not occur with statistical significance in those with ADHD + monitoring, but addiction is not the same as dependence. Dependence is implicit after continuous use, but, depending on baseline brain chemistry, different people revert to different baselines after discontinuation. - I feel your concern is more with the U.S. war on drugs in general - not specific users. I believe you want everyone who may benefit from stimulants to be able to find out if they benefit from them as easily as possible. The path to this is legalization - not stricter enforcement. On a more personal note, I have several friends who, by all external appearances, were doing just fine mentally, but did not make their physical health a priority. They got masters degrees, bought houses, held down solid white collar jobs. As we aged, continually ignoring their physical fitness and diet resulted in their bodies operating less efficiently, which began impacting their work, and so they sought legal help - and got it. Their personalities have now shifted to ones where they are always talking about their stimulants and how life is harder for them due to their diagnosis, but they still do not care for their bodies. They constantly search for the right dosage to make them magically better and become defensive when it's suggested that best results are achieved with both medical support and prioritization of personal health. It's really challenging for me to be supportive of this sort of behavior because I do not feel they are giving their bodies a fighting chance. I am now able to empathize with this mindset more fully having taken stimulants for a period of time. I felt firsthand how easy it was to ignore my health when there was a guaranteed window of time each day where I was able to live life fully attentive and stimulated. I feel that it is entirely possible that I have ADHD. I have some neurodivergent tendencies, but I see myself as strong, independent, successful, and not the sort of person who is interested in convincing a medical professional to greenlight my behavior. So, I researched and explored for myself, thought that stimulant use was potentially beneficial for a period of time, and then changed my mind when I reflected on the actual results. Was it illegal? Yes. Does that make it implicitly morally unjust? I don't feel that way. I felt morally worse convincing a doctor to prescribe me medical marijuana when California was still in the process of legalizing it recreationally even though the symptoms I stated, such as trouble falling asleep, were valid and "prescription worthy." Of course, you're fully entitled to see things differently, but it was important to me to fully share my perspective since I felt what I said prior was upsetting. Would love to hear your take on things. Cheers.
temptemptemp111 3y ago
[dead]
DueDilligence 3y ago
[dead]
fallingfrog 3y ago
People like to argue about what the proximate cause is of drug shortages. Or for that matter why we can’t build affordable housing or provide healthcare for everyone, or keep people from shooting up shopping malls. Honestly, I don’t care about the details of each individual problem, which are complicated and ultimately unenlightening. The big picture answer is this: America is becoming a failed state. Generally that happens because a small group of economic and political elites get too much power, and their interests begin to conflict with the interests of the general population. That’s the big picture. It’s just not in the narrow short term interests of the ruling class to actually solve these problems. And as long as that remains true, they will continue to get worse.

139 points by orhmeh09 3y ago

[dead]

We need to stop offering tax deductions for advertising and offer tax deductions for maintaining inventory. We are squeezing all of the safety margins out of our entire economy because that's what the beancounters tell us to do.

StreetChief 3y ago
Because that's how the rich get richer
- hinkley 3y ago
  Because the thing that makes them an extra 5% is what will be done. If we reward people 5% for cutting to the bone, they will, every time. See also perverse incentives. For medical supplies there should be a specific tax exemption for maintaining emergency supplies. Or a law, or both.
  - hammyhavoc 3y ago
    You'd get my vote.
  - jjeaff 3y ago
    No deduction. Just a law. If you want the regulatory privilege of providing important medications to the public, you must be able to continue to provide said medications during supply issues for national security purposes.
    - MichaelZuo 3y ago
      A law enacted with what votes?
    - hinkley 3y ago
      So that would have to be something contingent on FDA approval for your factory? I could see that. I would also expand that to include any drugs that require a tapering off period should require an emergency supply as well. We can't have people keeling over from methadone withdrawals because you decided to piss off your only vendor. In fact I might go so far as to say that you can't institute a price hike without a grace period either, which may or may not include one final prescription renewal at the old price.
      - devilbunny 3y ago
        Price hikes got a bad rap because of a few egregious examples, but they've been responsible for shortages, too. I'm an anesthesiologist. Almost all of our drugs are generic. But there have been shortages of one or another for most of the last 15 years. Why? Among other things, the federal government limited price hikes to a percentage per quarter that Medicare and Medicaid would pay (gross oversimplification, but close enough). This sounds like a great idea. But when you can't do a 100% price hike on a drug that sells for 40 cents per ampule, you can't pay overtime and do increased-tempo maintenance to keep a line running almost 24/7. So if one generic manufacturer quits making a drug that only has 2-3 sources, the others simply can't fill in the gap. Sometimes they stop making it because it's no longer profitable, sometimes because other factors (failing to pass an inspection, e.g.) cause a temporary shutdown. But if you can't double the price of a dirt-cheap drug, you often can't double your output (because the drug is cheap - it's the labor, packaging, and regulatory compliance that are expensive, and they scale per dose, not per kg made). This is a very different world from the famous cases you see in newspapers about huge increases in price for medications that have been generic for a long time, but it is there and it really does hit us.
        youainti 3y ago
        As an economist, thanks for using a proper price/shortage example.
jws 3y ago
Maybe we should take a page from farm subsidies and have pharmaceutical subsidies where the government will buy some quantity of expired inventory of important medicines. Price it at kind of the low end of what insurance companies would pay the pharmaceutical company, so they'd rather sell it to a consumer, but they can still make money on the government planned over supply.
refurb 3y ago
The drugs that have shortages are almost always generics. Those companies don't advertise, they run on razor thin margins - which is exactly why you have shortages because these companies will often just stop making a drug if it's not profitable.

stuaxo 3y ago

Someone going to start asking an LLM the right questions to work out how to DIY these ?

moonchrome 3y ago
If it's as accurate as it is for coding good luck with mustard gasing yourself.
orangepurple 3y ago
Total Synthesis by Strike
ftxbro 3y ago
It's illegal. Not that it would stop everyone, but a lot of people who DIY won't go there. They will do other projects. And if they are going to illegally DIY drugs to make money then they will make other ones instead.

bugglebeetle 3y ago

Since most drugs are the product of public research that then gets gobbled up and privatized by the pharmaceutical industry, we should just build out state capacity for their manufacture. Taking this one step further, we could even had a national healthcare system that monitors utilization and adjusts production accordingly!

deleted 3y ago
[deleted]
jbm 3y ago
Pre-Corona-destabilization, and pre-Trump, I wouldn't agree with you, but I do now; especially since we are in the middle of the Opioid crisis. The government can and will seize patents at will. Only a handful of people need to be "convinced" to share their knowledge on production, and there are enough laws and spying that anyone can be "convinced". If a hard left president of the US decided the US wanted to produce drugs, it would produce drugs and that would be the end of it. If children start dying because of drug shortages, this will happen.
- mensetmanusman 3y ago
  Coming from the materials technology arena, those solutions wouldn’t have been available day one if it came out of a government led lab. Government research has no means to pay for the extra effort and talent required to get things done quickly. Also, committee led research can float off into random areas with little applicability this century.
- tstrimple 3y ago
  > If a hard left president of the US Well that’s never going to happen.
version_five 3y ago
> Taking this one step further, we could even had a national healthcare system that monitors utilization and adjusts production accordingly! Yes I've heard that centrally planned economies are great at delivering goods.

whalesalad 3y ago

It took me 6 months to get back to a decent baseline after quitting Adderall cold turkey but I am really glad I did. I hate being dependent on a drug with limited access for survival. In all honesty it is truly no different than being an alcoholic or a crack addict. Virtually every interaction you ever have with a psychiatrist or pharmacist surrounding these meds is fraught with bullshit. It is easier, less stressful and arguably more dignified buy illegal drugs on the black market. Covid was a sobering event for me and it made me realize just how fragile our global economy / supply chain are. I want to be able to exist and survive even in a total collapse (which, tinfoil hat be damned is becoming a more and more realistic possibility). Step 1 was giving up the amphetamine salts.

soderfoo 3y ago
I have been plagued by issue after issue with getting my prescription filled correctly (dosage, timing, and shortages). I would prefer to come off of it completely, but my doctor has even managed to make that difficult. Any tips for just going cold turkey? I can't wait any longer for my psychiatrist to prescribe an alternative.
- TechBro8615 3y ago
  Not cold turkey, but if you can, taper off it. Then just be prepared to deal with groggy, slow, angry mood for three weeks.
  - chasd00 3y ago
    If you’re talking about adhd drugs like adderall then how do you deal with untreated adhd? It’s absolutely exhausting to me and maddening to everyone around me when I have to go without for whatever reason.
    - TechBro8615 3y ago
      I don't, that's why I keep taking them... but I've had periods of time where I lived abroad or didn't have easy access to the medication, so I had to taper off it. It definitely sucks, and especially after you stop using it, you'll feel especially slow and groggy. You'll also gain a lot of weight. But after a few months you'll feel pretty "normal," at the cost of having all your ADHD symptoms return.

motohagiography 3y ago

Drug manufacturing is a solved problem. There are no drug shortages, only pharma FUD.

alistairSH 3y ago
Care to elaborate? Supply problems don’t strike me as FUD, but market failures. They might be correctable, with the correct incentives, but they’re still a problem.
- oatmeal1 3y ago
  US healthcare is about as far away from a free market as there is.
  - alistairSH 3y ago
    I never claimed otherwise.
- renewiltord 3y ago
  Cut the FDA requirement and drug patents and I will get you higher quality drugs manufactured with full supply chain provenance for cheaper. The biggest secret is that getting on the good side of the FDA is about knowing people and all that usual shit. Americans choose shortages because they think bureaucracy gets them quality. Instead what it gets them is a lack of baby formula and military planes importing it from Europe (presumably only the few cans that would cause children to not instantaneously drop dead like they do in Europe where they don't put FDA labels on them).
herbst 3y ago
My small pharmacy here in Switzerland is cooking their own dextroamphetamine and it's cheaper than street prices. There is no shortage, just weird regulation issues

breput 3y ago

FDA drug approval should include a clause that requires a certain production rate per quarter along with an ongoing adjustment based on the number of prescriptions. If the applicant misses the production rate for one quarter, they agree to work with a second source drug producer to prepare for production. If they miss the next quarter's quota, the second source is allowed to sell the drug for no less than three years.

refurb 3y ago
It takes a long time to move production facilities. Even if the original company decides to move production to another facility, it can take 6-12 months to run test batches, tests and submit it all to the FDA for approval. I’m not sure drug companies need much incentive to not have supply issues. That’s lost sales. If you dig into the actual causes it’s usually because of DEA limits (Adderal) or massive off-label use (Wegovy) or the fact that the drug is generic and the margins as so small nobody is all that interested in selling it.

Scoundreller 3y ago

> Drug shortages and the quality problems that often cause them aren't limited to generic products, as evidenced by ongoing shortages of Adderall, Wegovy, Pluvicto, and others. These aren't very good examples. 2 of those are relatively new drugs, 1 with runaway demand (Wegovy has the same ingredient as Ozempic) and the other, Pluvicto is a radiopharmaceutical with a short shelf life (so any manufacturing problems have immediate effects). DEA regulations regulate how much amphetamine can be manufactured for production of Adderall, along with 30 day script limits, so there's not going to be a lot of slack in the distribution system, nor in patient's pill bottles.

Waterluvian 3y ago
> 30 day script limits Oh so it’s not just Canada that does silly stuff like this. My doctor has to remember to write “300 pills dispensed 60 at a time” rather than “5 repeats” or else I have to go waste his time for refills.
- Auracle 3y ago
  At least in Minnesota, my doctor can’t even do that. I need to contact him every time. I take three different controlled substances, one needs to be refilled monthly and the others are somewhere between 1-3 months each. It’s a mess and I feel like I’m bugging him every time. They’re busy enough without BS like that bogging them down.

monksy 3y ago

So the short end of the stick is that leaders that are in charge of the cateogries are asleep at the wheel and no one wants to point them out?

chroma 3y ago

The adderall shortage is because the DEA sets quotas on how much can be made per year. Despite increased prescriptions, the amounts produced have remained the same.[1][2] The Wegovy shortage is because it was recently approved to treat obesity. The number of new prescriptions was larger than Novo Nordisk predicted, so they're still ramping up production. 1. https://www.federalregister.gov/documents/2021/12/02/2021-26227/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment https://www.federalregister.gov/documents/2021/12/02/2021-26... 2. https://www.federalregister.gov/documents/2022/12/02/2022-26351/established-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment https://www.federalregister.gov/documents/2022/12/02/2022-26...

kileywm 3y ago
Very interesting document; however, the text seems to disagree with your adderall explanation. https://www.federalregister.gov/d/2022-26351/p-16 https://www.federalregister.gov/d/2022-26351/p-16 > According to DEA's data, manufacturers have not fully utilized the APQ for amphetamine in support of domestic manufacturing, reserve stocks, and export requirements for the past three calendar years 2020, 2021 and 2022. > Based on this trend, DEA has not implemented an increase to the APQ for amphetamine at this time. Which suggests that the DEA's quota for adderall is not (yet) to blame.
- heyoni 3y ago
  > The majority of the manufacturers contacted by DEA and/or FDA have responded that they currently have sufficient quota to meet their contracted production quantities for legitimate patient medical needs. “The majority” “legitimate patient medical needs” sounds like a bunch of trippy legalese. If it’s the majority of the manufacturers they contacted, doesn’t that mean that there’s at least one that has exhausted their production? Could that one perhaps be the largest one, like Teva? If that’s the case, then yes, there could be a shortage. And they’re not increasing it because there’s been a surge of “illegitimate” shops that have popped up and prescribed remotely since Covid that the DEA is investigating and/or shutting down. And that may not even be the real reason. Could be the understaffing issues quoted in august. Either way, that answer from the register is a non-answer.

deleted 3y ago

[deleted]

euroderf 3y ago

"sole-source suppliers, a concentrated market" Congratulations, America. You have re-created the Soviet economy. All of the problems of centralized planning & production, and with none of the benefits.

xyzzy_plugh 3y ago

The comments in this thread regarding illegal or casual use of adderall or other amphetamines without an underlying condition are really disheartening. In the USA it is already excessively difficult for those suffering from ADHD to get a diagnosis, find medication that works and maintain a ready supply without a buffer. Abusers are contributing to the environment worsening for those who need these drugs. These drugs can literally save lives from chaos and tragic ends. If these drugs help you live a more normal life, you are not an addict or an abuser. The cosmic tragedy here is that this type of medication is practically impossible to become dependent on if you have ADHD. If anything the problem is usually remembering to even take the medication. I fear that abuse will hamstring any efforts to lift production limits.

Dma54rhs 3y ago
It's very easy to get a prescription for ADHD meds in the USA, that is why Americans often struggle when they go abroad to Europe or other places to find doctors willing to prescribe them.
- junofan 3y ago
  The comment was talking about production limits. It is very hard to get a prescription filled.
SeanAnderson 3y ago
Hey. I'd love to talk to you more about this if you're willing? I have to assume your comment is in reference to my post. I apologize for saying something that upset you - it certainly was not my intent. My perspective on this is: - The process for getting prescribed Adderall is not objective. One is allowed to see multiple specialists and continue searching until one's perspective is seen and respected. Yes, there are objective differences in the brain, but brain scans aren't being used as the basis for issuing prescriptions. - Adderall, like all drugs, comes with a set of benefits and drawbacks. It's up to the user to decide if those are resulting in a net positive and they are allowed to change their mind at any time. So, it's reasonable to believe that someone who is undiagnosed may still either be, or believe they are, benefiting from the drug - and then change their mind later. Changing their mind does not mean that they retroactively become an abuser. - I would like a source for "practically impossible to become dependent if you have ADHD." There are plenty of studies that show addiction does not occur with statistical significance in those with ADHD + monitoring, but addiction is not the same as dependence. Dependence is implicit after continuous use, but, depending on baseline brain chemistry, different people revert to different baselines after discontinuation. - I feel your concern is more with the U.S. war on drugs in general - not specific users. I believe you want everyone who may benefit from stimulants to be able to find out if they benefit from them as easily as possible. The path to this is legalization - not stricter enforcement. On a more personal note, I have several friends who, by all external appearances, were doing just fine mentally, but did not make their physical health a priority. They got masters degrees, bought houses, held down solid white collar jobs. As we aged, continually ignoring their physical fitness and diet resulted in their bodies operating less efficiently, which began impacting their work, and so they sought legal help - and got it. Their personalities have now shifted to ones where they are always talking about their stimulants and how life is harder for them due to their diagnosis, but they still do not care for their bodies. They constantly search for the right dosage to make them magically better and become defensive when it's suggested that best results are achieved with both medical support and prioritization of personal health. It's really challenging for me to be supportive of this sort of behavior because I do not feel they are giving their bodies a fighting chance. I am now able to empathize with this mindset more fully having taken stimulants for a period of time. I felt firsthand how easy it was to ignore my health when there was a guaranteed window of time each day where I was able to live life fully attentive and stimulated. I feel that it is entirely possible that I have ADHD. I have some neurodivergent tendencies, but I see myself as strong, independent, successful, and not the sort of person who is interested in convincing a medical professional to greenlight my behavior. So, I researched and explored for myself, thought that stimulant use was potentially beneficial for a period of time, and then changed my mind when I reflected on the actual results. Was it illegal? Yes. Does that make it implicitly morally unjust? I don't feel that way. I felt morally worse convincing a doctor to prescribe me medical marijuana when California was still in the process of legalizing it recreationally even though the symptoms I stated, such as trouble falling asleep, were valid and "prescription worthy." Of course, you're fully entitled to see things differently, but it was important to me to fully share my perspective since I felt what I said prior was upsetting. Would love to hear your take on things. Cheers.

temptemptemp111 3y ago

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DueDilligence 3y ago

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fallingfrog 3y ago

People like to argue about what the proximate cause is of drug shortages. Or for that matter why we can’t build affordable housing or provide healthcare for everyone, or keep people from shooting up shopping malls. Honestly, I don’t care about the details of each individual problem, which are complicated and ultimately unenlightening. The big picture answer is this: America is becoming a failed state. Generally that happens because a small group of economic and political elites get too much power, and their interests begin to conflict with the interests of the general population. That’s the big picture. It’s just not in the narrow short term interests of the ruling class to actually solve these problems. And as long as that remains true, they will continue to get worse.