Businesses that have not taken the time to understand employee wellness will eventually need to make time for employee illness, absenteeism, and lower productivity. The issue of drug shortages, which have spiked in the past year, are the perfect example. Ongoing and active drug shortages (more than 300 of them) are the highest in a decade and nearly a third of hospital pharmacists reported rationing and delaying treatment, according to a just-released report.
These include the much-written-about shortage of Adderall (made by Takeda Pharmaceuticals) as well as drugs for cancer treatment, respiratory illness, and even an antidote for lead poisoning. Most often, the shortages we discuss mention families and patients. But don’t forget that those same people are also employees whose productivity and health directly impacts businesses.
The average American took four pills a day in 2017. Over two decades, the increase in prescriptions filled was 85%, according to Consumer Reports. It’s a strong bet that number has increased since the pandemic. A multi-agency government task force sent a report to Congress calling drug shortages a significant public health threat that can delay and in some cases deny critical care. Medication shortages have included stimulants, respiratory aids, cancer, and weight loss drugs—and hundreds of others. Being in the thick of a mental health crisis and an opioid crisis makes this issue prescient. On top of that, 60% of working Americans experience chronic pain. More of your employees than you could ever imagine will face a drug shortage that will, at some point, affect their work life.
To be clear, whether people are taking drugs they don’t need, or too many, is an entirely different topic. For the purposes of this piece, I will be talking about people who after careful consideration have made medication, such as stimulants, part of a larger care routine. I am one of those people. I am ADHD and I take medication, when it’s available, along a host of lifestyle changes that help me. I exercise, meditate, avoid sugar, go to therapy, and prioritize sleep. This helps, but not the way medication does. When I thought about how I would talk to my supervisor if I had to go weeks without stimulant medication, which I have, I honestly couldn’t imagine it. Instead, I am writing this post. I hope you gain a sense of empathy and a realistic view of the current situation, for all workers, but particularly for employees who are ADHD, because drug shortages and rising costs are not going away.
Shortages Are Here to Stay
“Complex” was the word the U.S. Food and Drug Administration (FDA) press release used to describe reasons behind the shortages. One reason for unexpected shortages is that many of the medications that Americans take are manufactured in other countries, making managing supply difficult. A new bill in Congress aims to bring drug manufacturing back to the U.S., mostly because some experts believe that supply chains cause disruptions for American consumers. While the legislation itself is hotly debated, including exactly the number of foreign-made drugs used by Americans, it’s clear that shortages disrupt the U.S. workforce, 60% of whom have chronic conditions.
Even medications made in the U.S. can also be incredibly difficult to procure. If a drug is a ‘controlled substance’, such as opioids and stimulant medications such as Adderall, there are tight controls on pharmacy orders and manufacturing. Quotas on the amount of a drug a person may take. These are dramatically different than they were before the Drug Enforcement Agency updated its rules around “red flag” prescribers” in 2018. This has had a significant impact on people who legitimately need these substances and do not abuse them to manage medical conditions.
What Managers—and Even Some Doctors—Don’t Know About ADHD
Employers, including HR and managers, should ideally understand how common it might be for a person’s daily performance to be affected by a drug shortage and how awkward a conversation about difficulty getting medication is to have with a manager or HR, even confidentially.
The CDC estimates that 20% of adults have an ADHD diagnosis, a neurological condition that begins in childhood and can affect people very differently. Coexisting neurological diagnoses (dyslexia, dyspraxia, autism) are common, as are mental health concerns, such as anxiety. Once thought to affect only young boys, research now shows women are as likely to inherit ADHD as men, although they are less likely to be diagnosed. In recent years, neuroscientists and psychiatrists have given the public a clearer picture of how ADHD affects the adult brain. Unfortunately, much of the research hasn’t been clearly reported or well explained, even to medical students and primary care physicians, who receive little training on learning disabilities and ADHD in medical school, says Ned Hallowell, M.D., a Boston-based psychiatrist who has written 21 books on the topic.
What Patient and Advocates Do Know About Controlled Substances
Patient advocates speaking for people with chronic conditions—everything from muscle pain to ADHD—are infuriated by the struggle to get medication, including making multiple calls to pharmacists and doctors each month. Often, they must change medications abruptly and pay higher costs for them. “It is possible to have a safe and well-monitored drug supply chain that also allows legitimate patients to have the medical treatment they deserve. As it stands now, patients are needlessly suffering due to the unreasonable restrictions imposed by the national opioid settlement,” wrote patient advocate Pat Irving, RN, in Pain Network News.
Many people whom I spoke to off the record for this story said they’d much rather have colleagues wonder why they need to come in late or leave early than explain the ridiculous number of phone calls to pharmacies, doctors ,and insurance companies they need to make to get a stimulant medication. One woman told me, “If you know, you know. The struggle is real and it’s a huge time suck.” Another said there are Facebook groups devoted to talking about which pharmacies have the drug and which do not. Some employees are managing medication shortages for themselves and their children. If they can’t get medication, that means they are leaning on other means of staying healthy that also take time—exercising more, eating less fast food, cooking healthy meals at home, journaling and taking time away from their screens to clear their minds. They may have started attending therapy groups or peer consultants or have enlisted a coach to help them with their ADHD symptoms. All of these are helpful, but they are costly and take time that some employers may not realize is crucial, not optional for brains to function well at work.
How Employers Can Help ADHD Employees
Take a cue from the Federal government. To avoid stigmatizing the 20% of Americans who are diagnosed with ADHD who use stimulant medication as part of their treatment plan, the FDA clearly stated, “We want to make sure those who need stimulant medications have access.” It followed with, “The lack of availability of certain medications in recent months has been understandably frustrating for patients and their families.” Sure, ADHD diagnoses are on the rise. But that’s often for good reason—many adult women were never diagnosed as children when ADHD begins. Eating disorders and ADHD are rising and were even before the pandemic. Stimulants are also used to treat binge eating disorder which affects 3.5% of women and 2.0% of men, according to the National Eating Disorders Association.
- Trust your employees. People diagnosed with ADHD are likely already micromanaging their lives because they know they have difficulty with executive functions, an umbrella term for skills that develop over time that include everything from math problem solving to working memory. Studies show when anxiety rises, executive functioning gets hijacked. That’s a very good reason to show employees trust and flexibility. That doesn’t mean there are no rules. Instead, it means creating an environment where team members can talk non-judgmentally about can best work together. In addition, purpose and clear goals are the prime motivators for ADHD brains. Many times, focusing on team pursuits and deadlines (versus individual flubs and single missed deadlines) is effective in getting the best out of an already anxious ADHD-er.
- Ask for a truthful explanation, without asking too many specific questions. What employees may not be saying? They are in considerable pain because they’re rationing a medication. Mysteriously leaving early or going offline? It could be they’re busy traveling farther to a pharmacy to get a prescription. Family issues can also be a factor. Imagine a parent or grandparent whose family member is sent home from school because they are not feeling well. Again, you might be thinking. But every behavior has an underlying issue. In this case, you may not be privy to the fact that a child went home ill because a family had to change his medication that month, and the school nurse wasn’t aware that a dose needed to be given at lunchtime. ADHD and other medications may be available in a variety of forms and switching them on a dime isn’t easy, especially for children.
- Think bigger picture. How does a medication shortage affect our workers’ resilience? Do you have built-in ways to help employees manage what might loosely be called health disruptions? Have you created systems that empower managers to resolve problems when health concerns conflict with work? There are no simple answers, but why leave it to the next crisis to wonder why so many employees are suffering? Start deputizing managers to track health issues within their teams and compare notes. You might, over time, be able to spot when people are experiencing health issues, even if you don’t know the specifics. Being more connected to employees’ lives, especially those with chronic conditions, leads to greater empathy and lessons about what kind of flexibility works and what doesn’t.
Understand why ADHD can be good for business.
Most of this piece has focused on the problems that ADHD employees face when there are shortages in medication. But let’s end on a high note. Some of the most creative, reliable, top performing employees and entrepreneurs have battled the symptoms of ADHD since childhood, so they’ve learned to effectively manage their work and life in ways that doesn’t necessitate revealing their diagnosis. One of those ways, along with exercise, getting therapy, taking time to sleep and rest as much as they work, is taking stimulant medication. “Stimulant medication and a knowledgeable ADHD coach can help people have dramatic turnarounds at work,” says Dr. Hallowell “ADHD can become a gift and when well-managed, with or without medication. ADHD brains have helped create some of the top entrepreneurs and innovations in this country.”
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