What do you do when the drugstore is out of your medication refills? Well, if you’ve remembered to refill before you’ve run out entirely, it’s usually no big deal – you can wait or go elsewhere.
The problems come when the drug is a) a controlled substance and b) the powers that be have controlled availability of the active ingredient a little too zealously, so that it’s in short supply, even for the pharmacies. This is the problem causing millions of people a lot of angst as they try to procure their stimulant drugs for ADHD in the face of a continuing national shortage.
I don’t take medications for ADHD, but I’ve experienced the problems of procuring refills for controlled substances before, and I can say it’s not just frustrating – it’s embarrassing and anxiety-inducing.
On several occasions, pharmacies have been out of clonazapam, the generic version of Klonopin, which I take on occasion for anxiety and, more recently, also for migraines. One time last summer, when I’d completely run out and was going through a particularly stressful time, the pharmacist told me he didn’t have enough to fill my 60-pill prescription.
He gave me a choice: I could either get 40 pills now and relinquish the other 20, or I could wait a couple days until the pharmacy had enough pills to give me the full 60 count.
He didn’t mean to put me in an awkward position, I’m sure, but the choice was cringe-inducing. If I took the 40 pills, I might come off as desperate, even addicted, as though I absolutely had to have them immediately.
I’d also have to sacrifice a third of the supply and would therefore have to beg for a refill from my physician earlier. That, in turn, would invite further scrutiny from my doctor, undoubtedly aware of the pills’ potential for abuse.
If I waited for full 60 pill refill, I’d just have to hope I didn’t start to panic too badly in the interim. And, just as bad, I worried the pharmacist might suspect that I was holding out for a bigger supply because I was selling or diverting my pills, or that he might write me off as someone who didn’t need the prescription in the first place.
Dr. Danielle Ofri, who writes about the meanings we attribute to medications and medical care, touches on this sense of shame in a recent post at the Times’ Well blog. She notes that controlled substances like clonazepam or ADHD medications, of which there is now a national shortage, carry extra “scrutiny and judgment” from doctors and pharmacists, compared to drugs taken for, say, a thyroid condition, or high cholesterol.
In the end, I opted for the 40 pills of clonazepam – but I later regretted it. For me, a key benefit of the medication to me isn’t so much the physical sedative effects, but just knowing that I have it around, that I could, if necessary, swallow a pill and within an hour feel an agonizing clot of anxiety melt away.
By extension, not having the drug available, or feeling I have to ration it makes every tinge of anxiety turn into an agonizing “should I or shouldn’t I?” decision. And since anxiety spirals, simply having to deliberate this way can easily exacerbate panic.
In interviews with my peers who take medication for ADHD, I’ve detected a similar strain of thinking. As they get older, many young adults don’t take Adderall or Ritalin every day on a set schedule, but, rather, take the drugs as needed, when they think they may need an extra boost of alertness or focus. Doctors often encourage this “as needed” approach.
ADHD easily becomes psychologically associated with one’s ability to perform. Just having the option of taking a stimulant can be calming and encouraging – and not having that option, by extension, can provoke serious anxiety. As the Times’ article on the stimulant shortage noted, “some patients say that they suffer almost constant worry that they will not get enough.”
Anxiety interferes terribly with focus, so it doesn’t take a genius to see that making people scrounge for their meds is hardly a recipe for wise treatment of distracted patients. (Especially, as PsychCentral’s director points out here, when the reason probably stems from overblown worries about a tiny minority of people abusing stimulants).
But the Drug Enforcement Agency, which sets production quotas for controlled substances like ADHD meds, is not exactly known for its subtlety or empathy. The Controlled Substances Act requires the DEA to make drugs sufficiently available to treat medical conditions, but does having extra meds around “just in case” count as medically necessary? I would argue yes, but I have a feeling the DEA would not agree.
ADDENDUM: If you’ve been taking ADHD meds since you were a kid or a teen and are freaked out by the shortages, I’d love to hear why. Please feel free to weigh in!
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Last reviewed: 3 Feb 2012