Shortage of Adderall, other drugs, leads to boost in medications compounded by Grand Rapids pharmacy

GRAND RAPIDS TOWNSHIP -- In the laboratory at Keystone Pharmacy, white-clad technicians carefully weighed, measured and mixed to the whirring sound of an electronic mortar-and-pestle blender.

This is where medications are compounded, and it is an especially busy place these days. A record number of drug shortages is prompting customers to seek pharmacies that can make their medications or alternatives that will do the job.

"One of the unique niches we fill as compounders is helping out with drug shortages," said David Miller, a pharmacist and the owner of Keystone, 4021 Cascade Road SE.

Adderall, a stimulant often prescribed for attention deficit disorder, is one of the most recognized examples.

In many cases, doctors have switched patients to Ritalin or Dexedrine. Manufacturers have been unable to keep up with the increased demand, so shortages have developed for those drugs.

That's where the compounding pharmacists come in: They mix the medications for customers with Ritalin or Dexedrine prescription.

They are unable to provide Adderall, however, because the ingredients are in scarce supply. Federal limits on the controlled substances are blamed by some for the shortage.

Tetracycline, an antibiotic commonly prescribed for skin, urinary tract and respiratory tract infections, is another drug that is in scarce supply. So is methylprednisolone, an anti-inflammatory. In both cases, medications can be compounded at a pharmacy.

More than 200 prescription drugs are listed on the Food and Drug Association shortage list. President Barack Obama has urged the FDA to work with drug companies on increasing medication supply and has asked the Justice Department to intensify its investigation into price-gouging claims.

In the meantime, customers are turning to pharmacists who can create the pills, capsules, liquids or creams they need by hand.

"It's very labor intensive," Miller said. "It takes an average of 45 minutes to fill a compound versus three to four minutes for a traditional prescription."

The pharmacy employs eight technicians to make medications. The equipment they use includes built-in safeguards. The bar code of each ingredient must be scanned by computer to ensure it is the right one. And the scale is connected to a computer to double-check that the correct amount is measured.

But not every tool is high-tech. Miller picked up an old-fashioned glass mortar and pestle, long a symbol of pharmacists. It is still used to mix some compounds, particularly suspensions, such as creams and ointments and liquid versions of medications given to children.

"You can get a lot of energy into the particles. There's nothing really better than this," he said. "You can get things to mix a lot better."

A mortar and pestle are used to create many of the medications created for pets. Miller uncapped a bottle of a foul-smelling liquid and offered a whiff.

"That's our fish-suspension base we make for kitties," he said. "It's real salmon, sardines and tuna."

Medication is added to the fishy liquid goes down much easier with cats than pills, he said.

The cost for compounded medications is usually not much higher for customers, Miller said. In some cases, prior authorization is needed from the insurance company, or the higher, brand-name co-pay charge instead of the generic co-pay. And sometimes, the compounded medication costs less than an expensive brand name drug.

Miller advised patients unable to find a prescribed medication to talk to their doctor and pharmacist.

"If they call four or five pharmacists and can't find it, it's time the doctor, the patient and the pharmacist come together to find an alternative," he said.

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