Have you ever bitten into an Adderall pill? If not, let me spare you: It’s an ungodly flavor, a tangy mixture of cat hair and metal. The taste is so unpalatable that most people, especially children, would never accidentally eat, say, an entire handful. As of last week, however, that might be changing, now that Neos Therapeutics, a drug manufacturer based in Texas, has started selling Adzenys, an amphetamine-based drug similar to Adderall being marketed specifically to children with ADHD.
Adzenys is the first-ever tablet of its kind that’s been formulated to dissolve on the tongue rather than swallowed like a normal pill. Apparently, it tastes like orange candy. (I requested a sample and expect a brick of legalese in return.) The extended-release drug was approved by the FDA back in January, and though it might be a “scary” thought that someone could confuse a daily dose of amphetamines for a Sweet Tart, Adzenys solves a number of issues for parents who haven’t had much luck getting their children to take prescription medication. A dissolvable tablet doesn’t need water, so it can be taken on the go. And a tasty pill becomes more of a treat than chore.
This welcome flexibility could conceivably help kids receive proper treatment and, in turn, concentrate and succeed in school. If children are taking the drug anyway, what’s the harm in making its consumption a little easier? Why should a parent have to sprinkle the contents of a pill into food as if their child were a dog?
[quote position=”full” is_quote=”true”]Why should a parent have to sprinkle the contents of a pill into food as if their child were a dog?[/quote]
William E. Pelham Jr., chair for the department of psychology at Florida International University, compared the dissolving tablets to drugs like Claritin. “Orally disintegrating tablets have been around for several decades,” he said. “Many psychoactive drugs are available in this form, but apparently this is the first formulation for ADHD. The delivery system of stimulants should not make a difference in effectiveness or abuse potential.”
Opponents of the pharmaceutical industry are crying foul, though. If our drugs feel like candy when we consume them, then the space between the two, which should be massive, begins to collapse. Vipin Garg, the CEO of Neos Therapeutics, isn’t helping his cause, either. Earlier this week, he told STAT that the company was putting its commercial muscle behind Adzenys so they could get “ahead of back to school season.”
Points for speaking like a cartoon villain, but this sort of sales-first, kids-be-damned style of drug marketing provides ammunition to those who argue we’re in the midst of an overprescription epidemic. And it’s an issue quite distinct from college students who abuse Adderall to save their GPA. ADHD is very real, and there’s a massive debate over whether too many children are on medication as a first line of treatment. As of 2011, the Centers for Disease Control and Prevention (CDC) estimates that upwards of 11 percent of kids under 18 are diagnosed with ADHD, a dramatic spike from the historical average of around 5 percent. Over a third of ADHD diagnoses are made before the age of six. The CDC recommends behavioral therapy before moving to medication, yet approximately 75 percent of children diagnosed with ADHD take pills for it. $12.7 billion in ADHD meds were sold last year, an increase from $4.7 billion from a decade ago, and a mere rest stop on the way to a projected $17.5 billion by 2020.
Pelham Jr. certainly agrees with the CDC. “That is the main story line for ADHD—how do we get physicians to stop prescribing meds as the first line?”
It’s a good question, especially in an ever-growing market with a future that seems imminently chewable. Just last month, Shire (which also sells Adderall) filed an application with the FDA for a new formulation of Vyvanse, one of the most popular ADHD drugs, that can be chewed rather than swallowed. Pfizer got approval last December for QuilliChew ER, an extended-release version of methylphenidate (aka Ritalin). Adderall, when pressed to the tongue, is already coated with a sweet flavor to encourage swallowing. (Just don’t bite into it. Trust me.)
[quote position=”full” is_quote=”true”]If amphetamine salts can taste like candy, the potential for a child to go all ‘Flintstones Vitamins’ on a fistful must be high. [/quote]
I asked Dr. Mark Bertin, author of Mindful Parenting For ADHD, about the importance of taste when it comes to medication. “Not taking ADHD medication because of flavor or texture is fairly rare,” he said. “If the flavor helps get rid of stress in a stressful situation, and if there’s no unique side effect, then it seems like another good option to have available. Although the fruit flavor would make me concerned a child would eat a bunch because they taste good. There may be a higher safety concern around that.”
What’s left is our medicine cabinets, which should be locked tight. I also humbly propose that in order to open these bottles, one must solve a math problem or an enigmatic riddle. If amphetamine salts can taste like candy, the potential for a child to go all “Flintstones Vitamins” on a fistful must be high.
Ultimately, it is the responsibility of parents to know both what and how much they are putting in their child’s body. If it’s easier when the medication disintegrates on their child’s tongue, then dissolvable tablets like Adzenys and chewy versions of major ADHD drugs on the way will find a receptive audience.
