I open my emails to find yet another message from a patient about their amphetamine-dextroamphetamine (the generic form of Aderall) no longer working. Dr. Plutchik, my meds no longer seem to be helping. Can we discuss increasing my dose or trying another stimulant? This has become a frequent refrain in recent months. Something was affecting the efficacy of certain amphetamine pills despite being dispensed from mainstream pharmacies.

So I started to ask my patients, Does the pill look different than usual? The answer often was yes, and then the detective work began. I had patients contact their pharmacies to identify which manufacturer made the ineffective batch of amphetamine compared to the previous amphetamines, which was effective. We were able to identify which companies had been providing amphetamines that were ineffective. I encouraged patients to report the problem to pharmacists as well as to request the generic version that previously worked. Many mainstream pharmacies claimed they could no longer obtain amphetamines from the reputable companies. My patients were often informed that the current generic manufacturer was the only one available. It turns out that some pharmacies are now dispensing generic versions of amphetamines that seem no better than sugar pills.

Generic medications are based on the concept of bioequivalency. This means that the generic version of a medication must have the same rate and extent to which the active ingredient is available at the site of drug action (U.S. Food and Drug Administration, 2021).

Brand name medications require extensive trials, taking years and substantial financial investments, to gain approval from the U.S. Food and Drug Administration (FDA). Generic drug development does not require that........

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