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Noem told reporters at a pharmacy in Sioux Falls last week that her state will expand its stockpiles of certain medications that have been in short supply. The Republican former congresswoman also used the occasion to turn up the heat on the federal Food and Drug Administration, urging the agency to make the U.S. less dependent on foreign suppliers like China and India.

Noem said she hopes other governors – and members of Congress – take notice of what South Dakota is doing and lend their voices to push for long-term change in Washington to fix what she called a real risk to national security.

“My hope is that those leaders in D.C. that have the ability to weigh in on this issue will,” Noem said. “We’ll continue to educate them on why it’s such a critical need for us to address it today.”

Shifting shortages of a variety of drugs predated the COVID-19 pandemic by decades and continue to complicate treatment of patients across the country. Major contributors include manufacturing problems, demand spikes, tight ingredient supplies and overreliance on foreign sources. A U.S. Senate report in March said the shortages have “cascading effects on patient care.”

Last fall, the FDA announced a shortage of the attention-deficit/hyperactivity disorder drug Adderall. Stores ran out of children´s medicines due to demand during last winter´s particularly intense cold and flu season. Prominent cancer centers warned last month that a growing shortage of common cancer treatments is forcing doctors to switch medications and delay some care. Several Democratic-led states plan to stockpile abortion-inducing drugs in response to a court ruling that could limit access.

There were 309 active drug shortages in the U.S. at the end of June, according to the University of Utah Drug Information Service. That´s up from 295 at the end of last year and the highest total recorded since 2014.

Noem wrote to FDA Commissioner Robert Califf last week, imploring him to work with Congress on long-term solutions to fix the supply chain and reduce America’s reliance on China and India.

“This is one of the issues that´s still getting traction in Washington on both sides of the aisle, which is rare these days,” said Stephen Schondelmeyer, a leader of the Resilient Drug Supply Project at the University of Minnesota.

South Dakota already maintains drug caches at each end of the state, at a pharmaceutical warehouse in Sioux Falls and at a Rapid City hospital. It will now add sites at partner pharmacies in five additional cities statewide. In addition to current antibiotic stockpiles, the department is adding albuterol, epinephrine, insulin, prednisone and pediatric amoxicillin to the list, which was developed by the state Department of Health as part of a study that Noem ordered in May.

“This effort is helpful, but not the whole picture,” Schondelmeyer said.

He noted that South Dakota´ plan focuses on outpatient medications. Serile injectables used in hospitals – ranging from drugs on crash carts to chemotherapy medications – have accounted for about 70% of the shortages over the past decade and may warrant stockpiling as well, he said.

Schondelmeyer estimated that around 15 to 20 other states, including California, also maintain some kind of drug stockpiles.

Noem said building up South Dakota’s stockpiles shouldn’t cause shortages or price spikes elsewhere across the country. The drugs in the stockpile will be rotated and released to pharmacies before they expire so they won´t be wasted.

The Department of Health is still negotiating contracts with the five additional sites and the costs associated with the additional medication stockpile, spokesperson Tia Kafka said. The quantities will be based on epidemiological data and community size, she said, and the contracts will become public record once they’re finalized later this month.

“This is an interesting solution,” said Erin Fox, associate chief pharmacy officer at University of Utah Health. “Stockpiling can help buffer shortage situations and are an appropriate step to take, but they can´t completely solve the shortage issue.”

Tom Kraus, vice president for government relations at the American Society of Health-System Pharmacists, said his group supports the concept of stockpiling as South Dakota is planning – including by states and individual hospitals – as long as it´s done carefully to avoid aggravating shortages.

The federal government also has its own drug and medical equipment stockpile, but its focus is different. The Strategic National Stockpile, run by the Department of Health and Human Services, assumes states will also have stockpiles and it´s meant only to supplement their efforts.

Fox said the country needs to fix some of the underlying issues that cause shortages in the first place, such as intense price competition in the generic drug market that causes quality to suffer and forces suppliers out of the market. And she said the federal government could fund extra supplies of drugs for “inventory buffering” to provide a margin of safety when problems develop, similar to what South Dakota is doing on its own.

“When you need a drug, it should be at the corner drug store or the hospital when you need it, and it isn’t,” Schondelmeyer said. “There are real market failures in the drug supply that need solutions.”

___

Associated Press reporter Tom Murphy contributed to this story from Indianapolis.

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Researchers in five states across the US studied more than 2,800 adults between 65 and 79 years old, of which 75 had been diagnosed with ADHD. They found adults with the condition were more than twice as likely to get a traffic ticket and 74 percent more likely to get into a car accident. 

Based on their findings, the researchers called for better treatment options for older adults with ADHD, which affects more than 40 million Americans and has led to twice as many prescriptions for medications to treat the condition, like Adderall in recent years. 

‘These findings suggest that effective interventions to improve the diagnosis and clinical management of ADHD among older adults are warranted to promote safe mobility and healthy aging,’ the study authors wrote. 

Older adults with ADHD were more than twice as likely to get a parking ticket and three-quarters more likely to get into a car crash than their counterparts without the condition

Prescriptions for Adderall surged during the COVID-19 pandemic. In February 2020, just before the virus erupted across America, the drug made up 1.1% of drugs. By September 2022, the figure had more than doubled to 2.31% of all scripts written

Researchers recruited 2,232 drivers ages 65 to 79 between 2015 and 2017 in five areas: Aurora, Colorado; Ann Arbor, Michigan; San Diego, California; Baltimore, Maryland; and Cooperstown, New York. Women made up 53 percent of the study population, while men made up 47 percent. 

Of the participants, 41.6 percent were 65 to 69 years old, 34.8 percent were 70 to 74 years old, and 23.6 percent were 75 to 79 years old. The 75 adults with ADHD made up 2.6 percent of the study population. In addition, 11.3 percent reported having anxiety, while 19.8 percent had depression.

The researchers found older adults with ADHD had a 102 percent increased risk of self-reported traffic tickets and a 74 percent greater likelihood of self-reported car crashes. They were also seven percent more likely to report hard braking, or slamming on the brakes with little warning.

The team speculated this could be due to adults with ADHD being more impatient, overestimating their driving abilities, having decreased reaction time and paying less attention. 

A limitation of the study was that it was based solely on participants self-reporting, which could have led to bias and inaccurate results. The researchers also did not know how severe each participant’s ADHD symptoms were. 

Attention deficit/hyperactivity disorder (ADHD) is a common disorder that is typically diagnosed in childhood, but recent years have seen an increase in adult diagnoses.

Neuroscientists have not pinned down a cause for ADHD, though genetics is believed to play a major role. 

The primary symptoms of ADHD, which typically manifest before age 12, include inattention and hyperactive-impulsive behavior. People with ADHD may be continuously fidgety, unable to concentrate on a given task, talk excessively, interrupt others and be easily distracted, among other symptoms. 

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The most important thing you can do to treat the problem is identify the underlying cause of the bad breath. The most common culprits include the following:

Your Child Lacks a Dental Regimen: Kids eat more sugary foods and tend to have a halfhearted commitment to dental care… they are much more interested in other (i.e. fun) activities. If your child is still quite young, you may need to remind your child of their dental regimen and even enforce or incentive it. Over-see their flossing and brushing… make it fun with cool products or games. For older children and teenagers, communicate openly about the issue, but most importantly, do not shame them. Rather, explain that bad breath can have health and social repercussions and that there are easy ways to avoid the discomfort and embarrassment. The long and short term benefits are worth the small time commitment.

Your Child Needs to See the Dentist: Your child should visit the dentist every 6 months to ensure that the mouth is clear of deeply-lodged debris, tooth decay, gingivitis and infection, all of which can lead to putrid smells.

Your Child is Dehydrated: Super-active kids can forget to drink fluids after rigorous activity. The resulting dehydration can lead to a dry mouth which creates a very hospitable environment for the anaerobic bacteria that causes bad breath. If your child participates in sports or is particularly active, be sure that they have easy access to water. Water is obviously the best choice, but sugar-free, non-dairy beverages are acceptable if your kid is particularly finicky.

Your Child is Taking a Prescription Medication: Some popular childhood prescription medications such as Ritalin and Adderall have been tied to chronic dry mouth, which often leads to bad breath. The best way to deal with this situation is to provide your child with plenty of low sugar beverages and dry mouth products that stimulate salvia product. Dry mouth remedies come in spray, lozenge / tablet and gum forms… let your child try each type and see which one they like best. Kids are surprisingly open to these products. In fact, I have found that some children become quite fond of “showing off” their dry mouth spray.

Your Child has an Undiagnosed Medical Condition: In some instances bad breath can be a sign of an underlying condition such as a bacterial infection in the sinuses or – in some rare cases – diabetes. It is important to report unusual bad breath symptoms to your child’s pediatrician or doctor as it may be an indicator of a more serious issue.

Your Teenager has Physiological Causes: While uncommon in young children, teenagers may have a physiological cause for the bad breath such as larger than normal taste buds or wisdom tooth infections. In most cases of teenage bad breath, it is wise to see a bad breath specialist or doctor. A clinic specializing in halitosis treatment will be able to identify these sorts of issues and create a comprehensive treatment plan for your son or daughter.

About Dr. Dailley: Dr. Dailley has been practicing dentistry since 1981 and founded the Center for Breath Treatment in 1996. He holds a degree in Cell & Molecular Biology from San Francisco State University as well as a Dental Degree from the University of the Pacific School of Dentistry. Dr. Dailley performs on-going research on medical approaches for getting rid of bad breath. Visit Dr. Dailley, the bad breath dentist with a 99% success rate.

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The U.S. Food and Drug Administration had said on Monday it has approved generic versions of Vyvanse from 11 drugmakers after Takeda’s exclusivity over the drug expired on Aug. 24. Copycats of the drug come in capsules and chewable tablets, ranging between 10 milligrams to 70 milligram doses.

U.S.-based drugmakers Mallinckrodt and Viatris , UK-based Hikma Pharmaceuticals and Indian drugmaker Sun Pharmaceutical Industries confirmed on Thursday they began shipping their generic versions of the drug, which is also approved for a binge-eating disorder in adults.

The generic drugmakers said they are working with the Drug Enforcement Administration (DEA) as the drugs are classified as a controlled substance.

Controlled substances are medications that can cause physical and mental dependence, and have restrictions on how the prescriptions can be refilled.

“We will be working closely with the DEA to request and secure additional quota to increase our production following this approval,” Mallinckrodt said.

Since October, the FDA has warned of an ongoing shortage of Teva Pharmaceutical Industries Ltd’s Adderall, after the Israel-based drugmaker had flagged intermittent manufacturing delays.

That shortage led to a jump in demand for Vyvanse, which combined with manufacturing issues, has resulted in a shortage of Takeda’s drug.

(Reporting by Sriparna Roy in Bengaluru; Editing by Krishna Chandra Eluri)

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