Doctors in England told not to start new patients on ADHD drugs due to shortage

Doctors in England have been told not to prescribe ADHD drugs to new patients because of a national shortage, as charities warn that the supply problems are devastating for people living with the condition.

A national patient safety alert from the Department of Health and Social Care said the shortages were down to a combination of manufacturing issues and increased global demand, and could last until the end of the year.

ADHD, which stands for attention deficit hyperactivity disorder, is described by the NHS as a condition that can make it hard to concentrate and may mean people act on impulse.

Prescriptions for ADHD have been rising in recent years. Figures for April to June 2023 show that about 202,000 individuals in England received one, up from 103,000 in the same period in 2018-19.

With about 2.2 million people in England thought to have ADHD, experts say the condition is under-diagnosed and under-treated.

Now prescribers have been told not to start new patients on medications affected by the shortages until the supply issues have been resolved.

The medications affected include methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.

“Other ADHD products remain available but cannot meet excessive increases in demand,” the DHSC alert states. “At present, the supply disruptions are expected to resolve at various dates between October and December 2023.”

Advice has also been given that healthcare professionals should identify all patients currently prescribed these products, check how much supply they have remaining and contact various dispensing pharmacy services or the patient’s specialist team for advice should their supplies be running low.

Henry Shelford, the CEO and a co-founder of ADHD UK, said: “ADHD is a disability and the sudden removal of medication is akin to removing a wheelchair from a disabled person that needs it. The NHS should have realised that this was happening and had a plan in place. Instead, people are only finding out when their pharmacy can’t supply. They’ve been left stranded with no support. It is an abject failure, but sadly this lack of care is something we’ve come to expect with our stigmatised condition.”

Shelford criticised the DHSC advice. “The Department of Health and Social Care sticking-plaster memo with the suggestion that GPs ‘reach out to a patient’s specialist team’ is laughable,” he said, adding that patients often waited years to meet the medication team.

“Medication is carefully given with dosage and type worked out over months. The idea it can be chopped and changed is wrong. The idea that specialist teams have the capacity to do medication reviews in this quantity is wrong,” he said.

“This is devastating for individuals across the country and will be life-changing for some. People with ADHD are being let down by the NHS. This is just the latest way in which we are being failed.”

Sheldon said the situation was also of concern for those hoping to start treatment for ADHD. “It’s going to be devastating for those diagnosed [who are] waiting to receive medication now knowing they have to wait even longer,” he said.

The current shortages are not the first to affect ADHD drugs this year. The DHSC previously warned of a shortage of atomoxetine capsules, a situation that is not expected to be resolved until next month.

Dr Andrew Hill, a senior visiting research fellow in the department of pharmacology and therapeutics at the University of Liverpool, said the problem lay in how medicines were sourced.

“The NHS often depends on only one or two foreign suppliers for key medicines. If these factories fail to supply, there is a high risk of shortages,” he said. “We had many problems during Covid when drug production was suspended in China and India. Last year there was a major shortage of amoxicillin to treat respiratory infections.”

He said a new approach was needed. “The European Union is passing new laws to safeguard supplies of critical medicines. Manufacturers need to send alerts if their supplies are at risk. It is time for the UK to do the same.”

A Department of Health and Social Care spokesperson said: “We are aware of supply issues affecting medicines used for the management of ADHD due to increased global demand, and we have issued communications to the NHS to advise healthcare professionals on management of patients during this time.

“We continue to work closely with the respective manufacturers to resolve the issues as soon as possible and to ensure patients have continuous access to ADHD medicines in the UK.”