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'Star Search: All Stars' Crowns Its Queen In A High-production, Gorgeously Gay Finale At Studio 13
Outside the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. Catch up on the entire series leading up to the finale: Episodes one, two, three, four, five, six and seven.
I came to the bar an hour early to solidify a spot. When we came for the Season 3 finale (and I'm so glad I did; Oblivion Westwood's talent number changed the course of my life) I was jumping to see over heads. Me and my group found our usual spot by stage right and watched as 12-or-so Frisbee impersonators rehearsed on the main stage. I spotted Sonny Noble in a surprisingly hot Joker cosplay walking with the best posture I've ever seen and Erotica Divine Belle pacing around the other side of the bar in scrubs.
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Beep Beep, wearing one of her coolest looks yet — somewhere between Twiggy and a Truffula tree — said the premiere and finale are the most stressful episodes. And I can see it — there's a frantic energy in the air that only comes when something monumental is about to happen.
Kimmy and Beep took the stage to kick off the night, fashionably late to the 9 p.M. Start time. And I stress the fashionably.
"We're looking for polish," Kimmy declares, noting the top three had two weeks to prepare.
Kimmy and Beep Beep during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Beep Beep during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Beep Beep during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageProduction numbers are always my favorite. To me, the point of Star Search — and maybe to drag? — is this concentrated form of artistry. You're making a universe on stage, every number world-building, and production numbers give performers the most freedom and the most time (seven-ish minutes) to do it. I've been looking forward to Ruth's all season.
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageIn a throwback to the Real Housewives challenge, Ruth brought back "Ruthalyn," her beautification drug/surgery/Botox/Ritalin equivalent. The details are vague, but hilariously so. In scrubs, flanked by Erotica Divine Bell and Paris Jackson Beverly Hillz, she performed a play in three acts. First, she introduces "Ruthalyn," dancing to "Pump It" by the Black Eyed Peas with comically large pink syringes.
In the next phase of the performance, the dancers retreat and Valencia Del La Barrio is lit by a spotlight while manning a newscasting puppet. The puppet-anchor reports that "Ruthalyn" is actually not safe. Lights come back up and the backup dancers return, wearing hockey masks smeared with Ruth's signature makeup. "Thriller" plays as the three hit some more well-rehearsed choreo.
In the third act, Valencia's back (same puppet, this time with a blonde wig) to announce a new update to the story: that Ruthalyn is turning people into zombies. Familiar drag performer Rotting Void, face obscured in a hockey mask, replaced Valencia on stage wearing a pink puffy dress. There was a record scratch as a classic Mommie Dearest scene is reenacted.
"Why can't you give me the respect I'm entitled to?" Ruth monologues, in full-blown Dunaway-as-Crawford melodrama.
"Because I'm not one of your fans!" Void retorts, flailing their arms. Then Void and the zombie back-up dancers tackle Ruth to the ground as the music fades.
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageVirgo is next, and also references a past challenge — Joker-Sonny is the only one on stage when Virgo approaches in a black and red Harley Quinn jumpsuit, reminiscent of her DC looks from the Dragula ball. Sonny turned to face the audience, lip-syncing to a clip of RuPaul saying "Hey, Porkchop!" She waved, then left the stage.
"Side to Side" began to play as Virgo entered view. Her makeup looked sharp and sleek, her wig a gorgeous, voluminous blonde. As she slinked towards the stage, Divinity Hope (as Catwoman) and Envy Oblivion (as Poison Ivy) sprung from beneath the judge's table and followed, Ariana Grande blasting over the speakers. Something about Virgo? She's gonna turn out a dance number. All three dancers were electric performers, totally matching the vibe of each song in the mix.
If that wasn't enough, Virgo left the stage and pulled a line of performers into the number, all dressed in her past looks. She sat in a stool as they surrounded her, and I got the metaphor. Every week, Virgo has said she was proud of what she had done. It's sort of incredible when you think about it, to love the things that you create so much, to have no regrets. Seeing all those looks on the stage behind her made me take a second to really honor what she had done here, and the way she did it.
Frisbee Jenkins performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Frisbee Jenkins performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Frisbee Jenkins performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Frisbee Jenkins performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageFrisbee had the most complex production out of anyone. About half of the max capacity of the bar was filled by just the people in her number. There was a V-shaped line of people with their backs turned to the stage, and as the music began, one by one they turned. They wore a fleet of Frisbee's looks from throughout the season, Eras Tour style — similar in theory to Virgo, but completely original. The models left almost as quickly as they arrived, and the next scene began.
As they left, a zoot-suited Domita Sanchez (one of the Des Moines crew) remained, previously hidden behind other performers. Adorned with a leopard print hat and manning a huge half-smoked cigar, they lip-synced to the deep-voiced man that narrates "Disco Clone" by Christina. Frisbee floated about in a short, bouncy black dress and Hairspray-esque black bob with cute '60s bangs.
As the narrator introduced the "Disco Clones," all the identical Frisbees entered the stage and began a choreographed number in a truly remarkable, certifiably no-doubt-about-it Frisbee Jenkins way. It was a real "I am Spartacus" situation, each person's makeup done so excellently there were moments I really didn't know who the real Frisbee was. And again, I can't overstate how professional it looked, every one of her — perhaps 50? Or more? — dancers having mastered it.
There were several more sections, a few famous Diahann Carroll lines from Dynasty, a group of tuxedoed dancers and a grand finale with everyone back onstage. It was, as always, a joy to watch.
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Ruth performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageThe theme of this runway is "Finale Extravaganza," of course.
Ruth is first in this lineup, too. She storms the stage in a shimmering nude bodysuit that sparkles with rhinestones. She wears a black straight wig and pink pumps with elevated Divine-meets-Jersey Shore makeup, bold blue eyeshadow and darkly lined lips. The bodysuit is seamlessly constructed, fitting her perfectly. She mock-sung into the (also rhinestoned) headset mic before taking it into her mouth.
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost performs during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageVirgo shows a different side than what I've seen before: an elaborate pageantry. She wears a black form-fitting gown, a bouquet of matching foxtails hanging from her wrist, and her ginger hair finds is elevated into an updo with ripples and folds that look as complicatedly woven as a brain. Her earrings are large obsidian gems, her makeup flawless. She holds a single finger out, almost testing the air, before taking delicate, achingly slow steps around the stage.
Frisbee Jenkins during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Frisbee Jenkins during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Frisbee Jenkins during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageWhen it is Frisbee's turn to walk, the music changes. To what, I could not tell you, as the roar of the crowd makes the switch almost unnecessary. The lights cut and several people holding black lights crouched along the runway, lighting up one of the most iconic looks in Star Search history. Frisbee's neon dress, earrings and bag, completely saturated by the blacklight, became explosions of color and texture, each rhinestone of the dress capturing the light and sparkling, as to never let the judges forget the craftsmanship behind the illusion. When the lights switch on, the dress is still just as impressive, painstakingly created by Frisbee over the course of three months.
Ruth, left, Virgo Frost, center, and Frisbee Jenkins during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village The judges paused the show briefly for pictures, mostly from friends trusted with iPhone cameras. When the judges ask everyone to leave the stage, there is an intentional stand still from the finalists. No one wanted to be the first to leave. Virgo (single finger still up, somehow never ceasing, never resting) planted herself firmly in place, looked only to the sky or towards a camera lens.
"Whoever leaves last gets points off," Beep Beep said, somewhat lightheartedly. Frisbee lingered a second, but saw, I think, that Virgo wasn't going to budge and made her exit. It was good sportsmanship. Ruth left next, carrying a lightness about her that showed she didn't take herself seriously enough to need to be last. Once the stage was clear, Virgo made the same slow, theatrical, very serious steps down the runway, relishing in it. And though it was maybe a little dramatic… I can't say she didn't sell it.
The judges weigh inAll the critiques began with compliments, and continued that way accordingly — for good reason.
"You are Popstar Ruth and you are amazing," said Kimmy with somewhat rare sincerity.
Ruth Lime, no doubt aware of the weight of Kimmy's words before the two finalists were picked, replied, "Can you say it like it's not a eulogy?"
Everyone matched Kimmy's sentiments as Ruth's journey was dissected and celebrated. Daphne Danger (the people's favorite guest judge and drag-crush of acclaimed Little Village columnist Finnegan Angelos) said about Ruth: "You're a breath of fresh air … you know how to make things more fun and remind us why we do this."
It felt so true in that moment. All of Ruth's humor, taste and skill culminated in this amazing season's worth of art. Ruth was always someone who made me excited to show up every Sunday. She always surprised me, and that is a gift.
Daphne Danger during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Myla Jade during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village"You've proved that you were a force in Iowa City … everyone has more respect on your name now," Beep Beep said to Virgo, still in her eleganza look. Virgo was the porkchop of her original season (the first one eliminated, even though technically she forfeited), as hinted by Sonny's line in the number. "You started as the wildcard and ended up in the finale," Kimmy said. "That's a rags to riches story if I ever heard one."
There was a moment of collective pride. Virgo seemed emotional on the stage, but before she could get too sappy, Myla grabbed the mic from Kimmy, "And you're mugged the fuck out." Too true.
During Frisbee's critique, I learned that she has the most wins out of anyone in Star Search, though I can't say I was surprised to hear it. "You're never gonna have a dead moment. And the runway? Fuck you. That's all I have to say," said Myla Jade — who, by the way, wore a perfect rendition of Ashley Tisdale's Princess Diaries 2 pajama party look. Gay Halloween done right.
"I'm proud of you," Kimmy said. "It's weird to say I'm proud of you because you're my mentor and my elder, but I'm proud of you." Even though everyone who knows anything about Iowa City drag knew Frisbee Jenkins was going to do phenomenally in this competition, I don't think anyone could have imagined just how good she was going to be. She brought an elevated vision to this competition that showcased what raw talent and experience can do.
Ruth speaks during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost, left, and Frisbee Jenkins applaud as Ruth exists the stage during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageWhen it was time to eliminate one of the top three, I was grinding my teeth. At this point, it could have been anyone. When Ruth Lime's name was called, I was surprised — but I would have been surprised by anyone. It was an impossible choice. She hugged her peers and left the stage.
An all-star lip syncThe final lip sync was set to Chappell Roan's "Good Luck, Babe," and the resulting performance was intoxicating. Two performers at the height of their ability, doing what they do best. It was one of those "you had to be there" moments. You can find footage on the Star Search Instagram, along with the talent numbers.
Virgo Frost, left, and Frisbee Jenkins during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village The song ends. Frisbee and Virgo find their places onstage. The judges deliberate in front of them, behind hands shielding lips, whispering.
"The winner of Studio 13 Star Search: All Stars… is Virgo Frost Belle." 
during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
An eruption of screams comes from the bar, Virgo immediately starting to cry. It feels like confetti is falling, but I don't think confetti is actually falling. She hugs Frisbee before a swarm of people the size of a football team rush the stage and embrace her in one of the largest group hugs I've ever witnessed. Jason, the bar owner, passes out free Jello shots to all. It feels like the last scene of A Christmas Carol. It's a perfect end to a perfect season. As Daphne said during Virgo's critique, "You're the success story of Star Search. You've shown everyone exactly who you are."
Virgo Frost, center, reacts after winning the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost reacts after winning during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost reacts after winning during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little Village
Virgo Frost reacts after winning during the finale of Star Search: All Stars, Sunday, Oct. 27, 2024, at Studio 13 in Iowa City, Iowa. — Joseph Cress/Little VillageNow I know I'm probably sappier than everyone at Studio 13 put together, but I just want to reiterate how incredibly lucky we, as audience members, are to experience this level of talent and dedication. It is not easy to be queer, to be "other" in any means here in the Midwest, especially Iowa in 2024. But it's these creative, visionary people — from long-standing pillars of community like Frisbee Jenkins to up-and-comers like Cindy Lux — that are the reason so many people, consciously or not, stick around. It's why I do. Because this town is enough, the art it makes is enough.
Eat your heart out, New York City.
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Severe Irritability In Children And Teens: A New Understanding
It wasn't until her daughter entered preschool that Holly Provan, a nurse in Los Angeles, began to worry. Compared to other kids, including her younger sister, Anna had a harder time coping when something wasn't going her way. When told to stop coloring or to leave the playground, she'd respond with explosive tantrums.
Between ages 5 and 9, Anna (her name has been changed) would have meltdowns several times a week, screaming, raging and crying for an hour at a time. A few times in elementary school, she ended up hitting other kids. The outbursts weren't premeditated; Anna just couldn't control her temper. "Seeing how bad your kid feels after they've come back to themselves — it's heartbreaking," Provan says.
At age 7, after several doctors' visits, Anna was diagnosed with disruptive mood dysregulation disorder (DMDD), a condition in children and adolescents, typically diagnosed between ages 6 and 10, that is characterized by chronic irritability and temper outbursts. But Provan couldn't find much information on how to help Anna. "My husband and I at the time were just like, 'I don't know if she'll ever be able to live away from home or to function normally,'" Provan recalls.
Irritability — a proneness to frustration or anger — is familiar to many of us. But in children with severe irritability, a hair-trigger temper can get in the way of making friends, getting along with siblings and doing well at school. Parents often express the feeling of walking on eggshells and often refrain from asking their children to do things they don't like in order to avoid an outburst. In the 11,000-strong Facebook support group for parents of DMDD kids that Provan helps to administrate, some parents are physically afraid of their kids.
There are few specific treatments, says clinical psychologist Melissa Brotman of the National Institute of Mental Health, who coauthored a review on the topic in the Annual Review of Clinical Psychology. But now, after years of severe irritability in children being mistaken for other mental health conditions, scientists are studying it as a condition in its own right. "We're starting to try and understand the problem from a brain-based mechanistic perspective," Brotman says.
Inside the irritable mindStarting in the 1990s, many experts saw severe irritability in children — often accompanied by energetic behavior and an inability to focus — as an early manifestation of the mania experienced by adults with bipolar disorder. Bipolar diagnoses, as well as prescriptions for mood-stabilizing and antipsychotic medications, skyrocketed among adolescents and children.
But by tracking children with severe irritability over many years, Brotman found that they didn't transition to bipolar disorder as adults; instead, they tended to develop depression and anxiety. Perhaps, then, Brotman hypothesizes, severe childhood irritability is an early manifestation of depression and anxiety-like disorders in adulthood.
As scientists furthered their understanding of irritability in children, the Diagnostic and Statistical Manual (DSM) for Mental Health Disorders created a new diagnostic category, DMDD, in its fifth iteration, in 2013. Children with DMDD often also have other conditions like attention-deficit hyperactivity disorder (ADHD) or anxiety, or have experienced bouts of depression. Severely irritable children may have more difficulty than usual coping with negative emotions like frustration, or managing when things don't go as they expect. They may have a harder time dealing with uncertainty and changes to their routines, says clinical child psychologist Spencer Evans, who directs the University of Miami's Child Affect and Behavior Lab.
Functional magnetic resonance imaging (fMRI) studies, which use scans to observe brain activity, have affirmed the notion that children with severe irritability respond differently to frustration. One 2019 study compared 134 children between 8 and 18 who had irritability and a diagnosis of DMDD, anxiety disorder or ADHD, with 61 non-irritable volunteers. As they lay in the MRI scanner, the children played a game, earning up to 50 cents for every target they hit — until the researchers intentionally frustrated them by deducting winnings, explains coauthor Wan-Ling Tseng, a developmental neuroscientist at Yale School of Medicine.
Though irritable and non-irritable kids reported similar levels of frustration, the brains of irritable children responded differently: They showed heightened activity in the striatum, a brain region important for processing rewards, as well as in the prefrontal cortex, key to regulating emotions and executing tasks. Some other studies have also hinted at unusual activity in the emotion-processing amygdala in frustrated kids, though Tseng's study didn't observe this.
To Tseng, the prefrontal cortex findings suggest that in irritable kids, prefrontal cortices need to work harder to focus. "It's more effortful for them," she says. (After the game, the children were given $25 to take home, in addition to their compensation for participating, so that they left with a positive experience.)
It's unclear how children's brains end up this way. Research suggests that many kids are genetically predisposed to developing severe irritability, says neuroscientist and child and adolescent psychiatrist Argyris Stringaris of University College London. Adverse environments that involve family conflict or violence are associated with irritability, as are patterns of acquiescence by parents when their child has tantrums, which might reinforce the behaviors. But "we don't know whether the cause is the parent, the child that elicits the parental response, or both, or some genetic component," Stringaris says.
New clues for therapies and treatmentsDMDD diagnoses are rising, but there's little concrete treatment guidance. A 2022 analysis of health records found that in the United States, DMDD patients between 10 and 18 were prescribed antipsychotics more often than people with bipolar disorder, and were more likely to get multiple medications. "These drugs have not been FDA-approved specifically for treating irritability or aggression among children in general," Evans says. Antipsychotics in particular should be used cautiously in children due to their side effects (though there are two antipsychotics approved for irritability in autistic children.)
"We're starting to try and understand the problem from a brain-based mechanistic perspective."
— MELISSA BROTMAN
Yet the increasingly evident links between irritability, depressive episodes, anxiety and ADHD point to different kinds of medications. Stimulants like methylphenidate (Ritalin) can help to reduce irritability and anger in youth with ADHD, while the anxiety and depression medication citalopram (Celexa) in combination with Ritalin can reduce irritability in youth where stimulants alone aren't effective.
For Anna, Ritalin had little effect, and an antidepressant caused her to hallucinate. A popular yet untested DMDD treatment protocol includes anticonvulsants, and one variety, the mood stabilizer divalproex sodium, seemed to give Anna an extra split second to think through the possible consequences before exploding into a tantrum, her mother says.
As researchers learn more about the underlying brain processes, they hope to develop better and more effective treatments. Some, meanwhile, are looking into non-pharmaceutical therapies.
Recently, Brotman adapted an established treatment for anxiety disorders that progressively exposes patients to things they fear, within the safety of a therapist's office. Adjusting the therapy for kids with DMDD, clinicians identified the triggers of 40 children ages 8 to 17 with DMDD-type symptoms. Then they simulated anger-provoking situations — such as asking the kids to stop a video game or to do their homework, and talked the children through how to constructively cope with their frustrations.
"I was very tentative at first, because it had never been done before, and we didn't know if it would make them more angry," Brotman says.
The clinicians also trained parents to ignore tantrums at home and reward constructive coping behaviors — an approach called "parent management training" that tackles reinforcing cycles within families. Remarkably, irritability symptoms decreased significantly in 65 percent of the children over the 12 weeks of the study.
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Most parents, including Provan, eventually settle on a combination of talk therapy and medications. While no parent wants to drug their child, Provan says medications can help make them more receptive to therapy, in Anna's case with a psychologist. And whether it was the treatment or Anna's growing maturity, the tantrums disappeared. Now 13, Anna is no more irritable than a regular teenager, though she is still managing anxiety and depression. Indeed, studies tracking DMDD kids suggest that irritability symptoms can taper off by late adolescence or young adulthood, while depression and anxiety can continue.
Provan says that kids with DMDD need better medical treatment options and better mental health services — as well as more awareness in general. Because Anna was judged so much for her hair-trigger temper, Provan wrote a short book — Poppy and the Overactive Amygdala — to build understanding and empathy.
Before she had Anna, she recalls, "I was that parent that was, 'Oh, screaming toddler — can't they control their child on an airplane?'
"So, I guess, just be nice to your fellow humans."
This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. Sign up for the newsletter.
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U.S. More Susceptible To Drug Shortages Than Canada
Supply chain issues are 40% more likely to lead to drug shortages in the U.S. Than Canada, according to a study from the Journal of the American Medical Association (JAMA).
JAMA looked at 100 reports of drug-related supply chain disruptions between 2017 and 2021 in the U.S. And Canada. Over that period, almost half of those disruptions led directly to drug shortages in the U.S., compared to just 34% in Canada, with the majority of those supply chain issues linked to delays in manufacturing, packaging or shipping.
As for why Canada seemed to be less susceptible to shortages, the study theorized that country has had a more cooperative relationship between drug manufacturers, government agencies, health care systems and wholesalers. In the U.S., the American Society of Health-System Pharmacists has also been sounding the alarm for more than a year, having tracked a record 323 active shortages during the first quarter of 2024 alone, ranging from cancer chemotherapy drugs to medications that treat attention deficit/hyperactivity disorder (ADHD).
The shortage in ADHD drugs has been particularly prominent, driven by a combination of tight regulatory restrictions on distribution and manufacturing, and a rise in ADHD diagnoses globally dating back years, according to the Centers for Disease Control. The U.S. Food and Drug Administration officially declared a nationwide shortage of Adderall — a widely-used ADHD treatment — in the fall of 2022, followed by shortages for a slew of popular alternatives, such as Vyvanse, Focalin and Ritalin. In September of 2024, the FDA raised the threshold for the active ingredient in Vyvanse that U.S. Manufacturers could produce yearly by 24%, although other ADHD medications have still proven difficult to find at pharmacies.
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