In a follow-up psychiatric appointment, Joey wanted to try a new medication. He had read online that Sunosi (Solriamfetol) is a medication for narcolepsy-related daytime sleepiness and seems to help with treating ADHD. I told him that this report was a preliminary study and had not yet been approved for ADHD. I also reminded him that just last week, he had discussed how Vyvanse was working for his ADHD symptoms. “Well, Doc, but maybe this will be better......”
I am used to people eager for ADHD and wanting to switch things up. I also know that the pharmaceutical industry works hard to make their products appealing in some ways and promotes concerns that you might miss out on something that treats the condition better.
Pharmaceutical companies are not only good at manipulating potential patients but also at expanding government regulations, including "orphan drug" laws. Orphan diseases are those very rare conditions for which the drugs developed or brought to market by pharmaceutical companies are often not worth it. Before the government created economic incentives for companies to develop treatments, these rare conditions were indeed orphans, with no one to help care for them.
In 2019, the FDA approved Sunosi as an orphan drug for narcolepsy. Many drugs designed for one disease can be applicable to completely different conditions. The anti-tuberculosis drug Isoniazid is one of the earliest effective antidepressants. Therefore, medications like Sunosi that help reduce daytime sleepiness may also enhance focus, reduce distractibility, and help organize thoughts for individuals with ADHD, which is not a huge stretch.
I am glad our government encourages the search for effective treatments for very rare conditions that may be overlooked. However, who are the primary beneficiaries of the orphan drug law, the patients or the pharmaceutical companies?
Exploring who is currently helping whom and who may benefit in the future clarifies how the Orphan Drug Act shapes drug decisions...