The ongoing struggle to obtain Adderall prescriptions has become a harsh reality for individuals with ADHD. For approximately nine months, patients have faced significant obstacles in filling their prescriptions for this crucial medication. Now, the situation has escalated, with shortages extending to other ADHD drugs, including different forms of methylphenidate, known commonly by brand names like Ritalin and Concerta. This expanded shortage has plunged millions who depend on these medications into a state of uncertainty, marked by frustration and bureaucratic hurdles.
While the Adderall shortage has been a persistent issue, the availability of alternative ADHD medications has also become inconsistent. Dr. Michael Ganio, a senior director at the American Society of Health-System Pharmacists (ASHP), notes that these alternatives are now only “intermittently available.” This new wave of supply disruptions is proving to be just as challenging for patients as the initial Adderall shortage. The restrictive nature of ADHD medication prescriptions, limited to 30-day supplies with mandatory monthly renewals, exacerbates the problem. Patients are unable to secure longer supplies, even when willing to pay out-of-pocket, creating a recurring cycle of medication scarcity and pharmacy visits.
Attention-deficit/hyperactivity disorder (ADHD) affects a significant portion of the population. Data from the Centers for Disease Control and Prevention (CDC) in 2016 indicated that over 6 million children have been diagnosed with ADHD, with 60 percent receiving medication as part of their treatment. Furthermore, approximately 4.4 percent of adults in the U.S. have been diagnosed with ADHD, and around 4.1 percent of them are treated with medication. This translates to millions of individuals relying on these drugs to improve concentration and manage daily responsibilities related to work, education, and personal relationships.
The increasing number of adults seeking treatment for ADHD has contributed to the demand for medication. Since 2015, pharmaceutical treatment for ADHD has become more prevalent among adults than children. Analysis from Shire PLC, the former manufacturer of Vyvanse, revealed that in that year, adults accounted for 53 percent of the 63 million ADHD medication prescriptions. While this surge in demand is a factor in the shortage, it’s not the sole determinant.
Unpacking the Reasons Behind the ADHD Medication Shortage
Drug manufacturers are obligated to inform the Food and Drug Administration (FDA) of any drug shortages, but they are not required to disclose the specific causes of these supply interruptions. Like other drug shortages across the nation, the reasons behind the ADHD medication scarcity are multifaceted, ranging from manufacturing complications to an increasing patient population.
The Adderall shortage of the past year arose from a confluence of factors, creating what experts describe as a “perfect storm” that disrupted the established balance of supply and demand. The COVID-19 pandemic played a significant role by driving a shift towards telehealth for medical consultations. This increased accessibility to healthcare led to a notable rise in Adderall prescriptions.
CDC data highlights a significant increase in stimulant prescriptions during the pandemic. Between 2020 and 2021, the percentage of girls and women aged 15 to 44 and men aged 25 to 44 receiving stimulant prescriptions increased by over 10 percent, a substantial jump compared to smaller increases in previous years. It’s important to note that while these prescriptions are often for ADHD, stimulants like Adderall are also used to treat other conditions such as narcolepsy.
This surge in prescriptions is likely attributable to both increased access to healthcare through relaxed telehealth regulations and a growing number of individuals seeking mental health support, including ADHD diagnosis and treatment, during the pandemic. Dr. Craig Surman, an associate professor of psychiatry at Harvard Medical School, suggests that the pandemic provided individuals with both greater access to care via online platforms and more time to address their health concerns due to changes in work and commuting patterns.
Interestingly, the shift to remote work during the pandemic had varied effects on individuals with ADHD. Some found the structure of an office environment essential for managing their ADHD symptoms, while others discovered that working from home offered a less distracting setting. Dr. Surman emphasizes the complex relationship between structure, accountability, and the impact of ADHD, noting that environmental changes can either improve or worsen symptoms depending on individual circumstances.
Increased healthcare accessibility, coupled with rising demand that manufacturers struggled to meet, contributed significantly to the shortages. Dr. Meghan Schott, a specialist in treating children with ADHD in Washington, D.C., explains that the Adderall shortage forced doctors to prescribe alternative medications, further straining the supply of these alternatives. Pharmacies faced challenges in stocking adequate supplies, and many stopped consistently prescribing Adderall due to availability issues.
Patients, encountering difficulties in filling their prescriptions, began contacting multiple pharmacies to locate their medication. However, prescriptions for these controlled substances are not transferable between pharmacies and require a new prescription from a doctor for each location. This process further complicated the situation and added to patient frustration.
Insurance coverage complexities add another layer to the problem. Brand-name medications are not always covered when generic versions are unavailable. This creates a monthly ordeal for pharmacists and pharmacy technicians who are constantly fielding inquiries and searching for medications. The widespread patient-driven pharmacy searches also contribute to the disruption of previously stable demand patterns, as noted by Dr. Surman.
Potential Solutions to Resolve the Medication Shortages
Addressing the ADHD medication shortage is not simply a matter of increasing production. These medications are subject to stringent regulations due to their classification as Schedule II controlled substances. According to the Department of Justice, Schedule II drugs, which include amphetamine (an active ingredient in Adderall), have a high potential for abuse and may lead to severe psychological or physical dependence.
While the DEA, FDA, manufacturers, and pharmacists collaborate to anticipate and manage potential shortages, accurately predicting demand and supply needs is challenging. Manufacturers must obtain quarterly production quotas from the DEA. Pharmacists then request stock from wholesalers, who may not always be able to fulfill orders completely.
Recognizing the severity of the Adderall shortage, some members of Congress have urged the DEA and FDA to take action. Representative Abigail Spanberger and Senator Ron Wyden have sent letters to federal agencies pressing for solutions to alleviate the shortages and demanding greater transparency from manufacturers and regulatory bodies. Senator Wyden highlighted the difficulties faced by constituents, particularly in rural areas, and emphasized the need for clearer guidance for manufacturers navigating the bureaucratic processes involved in increasing production.
Dr. Ganio points out that obtaining increased production quotas is a time-consuming process, preventing manufacturers from rapidly scaling up production to meet immediate demand. This regulatory bottleneck further prolongs the shortage and its impact on patients.
For individuals with ADHD, the consequences of medication shortages are profound. Untreated ADHD can have serious long-term effects, increasing morbidity, mortality, and the risk of accidents. Dr. Surman emphasizes the life-sustaining role of ADHD medication, citing studies that show individuals with untreated ADHD have a higher average mortality rate and are more prone to accidents. In adults, medication can significantly reduce the risk of car accidents, while in children, it is crucial for managing hyperactivity, preventing behavioral problems in school, and supporting academic success. Dr. Schott underscores that for children struggling with ADHD, medication is not just helpful but essential for daily functioning and preventing negative outcomes.
