Drug supply crisis as half a million patients with ADHD and mental illness face shortages and rationing

More than half a million patients face shortages of vital medications as Britain is hit by a crisis in the supply of drugs, The Independent has been told.

The NHS has issued warnings over the shortages of nine key medications for conditions including schizophrenia and bipolar disorder. Patients have been left to search for pharmacies with stock, ration doses, and use potentially less effective medications.

Education experts warn that shortages of ADHD (attention deficit hyperactivity disorder) medication this year have already had an impact, with pupils missing school as they try to manage their conditions.

Worsening shortages of drugs have been impacted by fragile supply chains which have occurred following the pandemic, according to Mark Dyan at the Nuffield Trust.

Nine government “serious shortage protocols” are in place for the antipsychotic drug quetiapine – sold as Seroquel – which is used by around 250,000 people in the UK. The Department for Health and Social Care (DHSC) has warned pharmacists and doctors about shortages of quetiapine until at least September.

ADHD patients also face shortages, with NHS doctors in the South West being told to no longer prescribe methylphenidate. Sold as Ritalin or Concerta, the drug is taken by more than 275,000 NHS patients.

Ian Hamilton, an honorary fellow in mental health and addiction at the University of York, warned of the consequences for patients forced to stop their treatment suddenly.

“Ritalin can be addictive, meaning that when someone stops taking the drug abruptly, they will experience significant withdrawal symptoms such as fatigue, irritability and depression,” he said. “Denying a person quetiapine, an anti-psychotic medication, is also very serious. For most people, the risk will be to themselves if they are not able to access quetiapine.”

Steven Kitchen, chief executive for Bipolar UK, stressed that patients with bipolar disorder need their medication to stay well or their symptoms can get worse.

He said: “They can do a lot of damage to themselves and those around them before they get to the point where they are in the awful scenario of having to be sectioned because they’re so unwell. The suicide risk for bipolar is really high. People rely on this medication to stay alive.”

Mr Kitchen said it can be difficult to come off an antipsychotic once it is working for someone and it can take months to switch to another drug. Often, patients are unable to see a psychiatrist or even a GP to help do so.

“People are being left to their own devices,” he said. “This is a recipe for disaster.”

According to the DHSC, although shortages of other ADHD medications have eased, there continues to be an issue with methylphenidate.

In the South West, doctors were told that new patients could not be started on prescriptions of the 12-hour dose and were instead being offered shorter-acting versions. The NHS has seen a sharp rise in ADHD medication prescriptions for adults, up from 119,000 patients in 2022-23 to 152,000 last year. The number of patients aged 17 and under rose from 121,000 to 123,000.

In September last year, a national patient safety alert was issued over shortages in the supply of ADHD medication. Supply issues were expected to be resolved by December 2023 but problems have continued, blamed on manufacturing issues and an increase in global demand.

Concerns have been raised about the impact on children who use medication like Ritalin to deal with their ADHD, particularly with the new school year fast approaching.

Niamh Sweeney, deputy general secretary of the National Education Union, said: “This issue has already caused many young people to miss school because of their anxiety without medication, or exclusion and suspension due to difficulties in regulating their behaviour without medication. It is a situation that needs to be remedied swiftly.“

Dr Rory Conn, a paediatric liaison psychiatrist in Devon, added: “Just this week, I have had several patients for whom things are rapidly falling apart. They need to take more frequent doses, which are less effective for them. The experience is of intermittent control rather than consistent control.

“If we were having this issue with medication for a serious physical health condition, there would be a national outcry.”

The paediatrician said what began as a temporary shortage has dragged on with no sign of a resolution, warning that the issues have “significantly worsened in recent months”.

For patients already on the 12-hour medication, medics were told to consider treatment breaks, alternative formulations or switching to a different form of treatment, lisdexamfetamine, which will not work for some patients.

Labour MP Rachael Maskell, a former NHS care worker and physiotherapist who has sat on the Commons health committee, said: “Clearly there are very serious consequences for people who are dependent on medication if there’s a shortage. So this is a very urgent matter that the government needs to get on top of.”

A DHSC spokesperson said the recent supply issues with most ADHD medicines have now been resolved but the department was aware of ongoing global supply problems impacting methylphenidate prolonged-release tablets.

They said it was working with manufacturers of both types of drugs to resolve the issues, adding that the shortage protocols on quetiapine had been issued to allow pharmacists to supply different strengths and avoid patients having to search for stock.