Some medications in short supply at local pharmacies as demand outstrips production

Prescription drug shortages are becoming a growing concern as pharmaceuticals ranging from Adderall for attention-deficit hyperactivity disorder to amoxicillin for infections run into short supply.

The U.S. Food and Drug Administration has said that the Adderall shortage could be an issue until the new year, affecting both adult and child prescriptions, while the amoxicillin shortage could extend well into next year.

States such as Oregon have reported amoxicillin shortages, while UW Medicine on Monday warned about the Adderall shortage.

Pharmacist Ted Perillo of Tacoma’s Lincoln Pharmacy said Tuesday while he hadn’t seen a run on amoxicillin, Adderall only was available by allocation from wholesalers, making in-house availability hit or miss.

“For most wholesalers, which is what most pharmacies go through, they’re under what they call an allocation basis,” Perillo explained. “The wholesaler gets an order of 100 bottles of any particular strength, and usually they would get maybe 500. What they’re going to do is allocate it. So normally, if we’d order five bottles, they might allow us to order one bottle.”

The result is some strengths of the medication might be on hand, while others might be out for a week, he noted.

Local health systems appear to be benefiting from their in-house stockpiles.

Scott Thompson, media representative for Tacoma-based MultiCare, told The News Tribune in response to questions, “We are managing these shortages at our hospitals, and there’s not been any impact to our care. We continue to monitor the situation closely.”

Kaiser Permanente told The News Tribune it was stockpiling to avoid a shortage.

The difference in the antibiotic and Adderall shortage is that while there are antibiotic substitutes for amoxicillin, Adderall can be harder to switch out.

High demand is blamed for both shortages.

Risk of Adderall withdrawal

UW Medicine psychologist Maggie Sibley, in a statement Monday, said, “There’s a lot of options out there, but what works for whom depends on several factors about you, about your biology, about your lifestyle.”

Sibley is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.

Stopping Adderall, she noted, can lead to withdrawal symptoms.

“I think where a lot of the struggle comes from, though, is that a lot of times when people are used to taking their medication and then they stop taking it, actually they feel worse than before they took it, because their body has kind of adapted to that medication,” she said in a presentation released by UW Medicine.

She added, “Ultimately, we all want to empower people with ADHD to be able to cope in these situations where they might not be able to take their medication. A shortage might not be the only reason that somebody might not be able to take their medications. What if you go on a business trip and you forget your pill bottle, and you have to present an important meeting?”

The shortage was announced by the FDA in October. The drug is used in treatment of not only ADHD but narcolepsy, a chronic sleep disorder that causes sudden onset of sleep outside of normal sleep patterns.

The New York Times reported Nov. 16 that a major Adderall producer, Teva Pharmaceuticals, faced a labor shortage more than a year ago, disrupting manufacturing. While those delays were resolved, a company spokeswoman told The Times that a demand surge is now the predominant cause for back orders.

Antibiotic demand outpacing supply

The early onset of respiratory illnesses this fall, particularly among children, has been blamed for driving up demand for amoxicillin, with the FDA reporting an amoxicillin shortage Oct. 28.

Viral infections can lead to secondary bacterial infections, a concern in the current Respiratory Syncytial Virus Infection wave overrunning pediatric care in Washington state and elsewhere.

There’s also the risk of over-prescribing antibiotics in times of a viral illness.

Dr. Michael Alston, a Kaiser Permanente pediatrician, emphasized that point in a presentation about treating respiratory infections on Friday to Tacoma St. Mark’s Preschool parents.

“In cases where you are worried about pneumonia, or an ear infection, we may think about antibiotics, but in the vast majority of these cases, they’re not helpful,” he said.

The American Society of Health-System Pharmacists on Nov. 18 listed 29 varieties of amoxicilln and clavulanate on allocation or back-order from manufacturers.

The news was first reported Monday by Becker’s Hospital Review.

Amoxicillin is a penicillin-like antibiotic that stops bacterial growth. Clavulanic acid is a beta-lactamase inhibitor that prevents bacteria from destroying amoxicillin.

The drug combination is used to fight infections of the ears, lungs, sinus, skin and urinary tract.

According to Becker’s Hospital Review, amoxicillin resupply dates “have been pushed to be between early December 2022 and August 2023, depending on the company and the product.”

Kaiser Permanente, in an emailed statement sent in response to questions, told The News Tribune on Monday: “Similar to other healthcare systems in the area, we are experiencing pockets of local surge in demand for some antibiotics.”

The health system said it was “closely monitoring the supply situation, both at our own pharmacies and at the wholesale level. Clinical alternatives are available based on the treatment indication.”

It added that the health system also “has been warehousing some additional drug supply to help ensure we have adequate supply for our members and patients.”