It cannot have escaped your attention (excuse the pun) that ADHD meds have become the latest drugs to have supply issues. This is a timely reminder that ADHD can have a huge impact on people’s lives. It is associated with higher rates of mortality, RTAs, criminality, drug misuse and school exclusion.
Some of our patients will truly be significantly impacted by the shortages, and we will want to prioritise those with high risk behaviour such as aggression, police involvement, school exclusion and serious self harm. ADHD may be part of a complex mental health multimorbidity, and a sudden absence of meds can lead to a crisis. So what can we do to support our patients whilst we weather the storm?
Supply issues are expected for the next few months and up to date information can be found on the specialist pharmacy service site. It is not an issue of NO stock, more of limited or restricted stock. It is helpful to know what the supply is like in your area – ideally, your ICB should be co-ordinating this, with updates on supplies and help and information in collaboration with your AMHT ,CAMHS and medicines teams, as well as prescribing advice for alternatives. There are limited supplies and there are time frames for upcoming availability. If you are not getting this kind of information, then ask your LMC to advocate for you. Changing the prescription to EPS ‘any pharmacy’ can also help your patient to source the meds themselves from the pharmacies that do have stock.
In the meantime, what other support can we offer our patients? As is so often the case, medication is just part of the solution, a piece of the puzzle, but it is absolutely not the whole picture. It is a good opportunity to see if the non-pharma options have been harnessed to their full benefit. There are plenty of options to help your patients, and by creating a template with your text messaging service, you can quickly convey this information to your patients.
Behavioural support can be accessed via organisations such as the ADHD foundation. They have a wide range of videos, podcasts and downloads to help with concerns such as sleep support, preparing for exams, impulse control and risk management, supporting social skills and relationships, and staying calm and positive.
CBT is very helpful for many people with neurodiversity. Low self-esteem is prevalent, as many people will have frequently been told that they are lazy or disruptive on a regular basis, and the frustration with not being able to achieve as they would like to can be difficult to come to terms with. CBT can also be helpful for those common issues such productivity, executive function, problem solving, and active listening skills. There is good range of free CBT modules on CCI and NHS Scotland has a free module on problem-solving
There are now a plethora of apps to help people with ADHD. Time management is a perennial issue and there are apps that help to organise time, block distractions for a period of time, track how much time is being spent on activity (to help that rabbit hole from becoming the Channel tunnel…) and assist in managing procrastination. There is a good overview of apps here by a self confessed tech geek with ADHD on the ADDitude site and also a good round up from Devon NHS Trust
Sleep disturbance is an incredibly common issue in ADHD and the ADDISS website has a very useful download for parents who are struggling to manage their child’s ADHD sleep and the ADHD foundation has a page of different resources here
Exercise is well recognised for its mental health benefits and anecdotally helps keep the fidgets at bay. In addition, it has become more apparent that the benefits go further than this in ADHD, helping to improve attention, impulsivity and executive functioning. People with ADHD tend to experience hypoactivity in dopaminergic and noradrenergic systems in the pre-frontal cortex, and one of the benefits of exercise is to increase productivity of https://www.adhdfoundation.org.uk/https://www.adhdfoundation.org.uk/neurotransmitters.
A lot of our patients will be frightened and stressed at the prospect of running out of meds, and the families, partners, carers and teachers of them may be significantly affected as well. By sharing these resources, and helping them to get their meds using the supply information here, we can help them to weather the storm.
The websites below all have a great range of resources for our patients, and for our NB plus subscribers, there is a CPD module on ADHD
The ADDISS bookshop has a huge range of curated book, for children, teenagers, adults and parents