The United States is facing a surge of attention deficit hyperactivity disorder (ADHD) diagnoses just as there is a shortage of a key medication used to treat it.
Officials at the Food and Drug Administration (FDA) placed Adderall on their official drug shortage list this week.
“The FDA is in frequent communication with all manufacturers of amphetamine mixed salts, and one of those companies, Teva, is experiencing ongoing intermittent manufacturing delays. Other manufacturers continue to produce amphetamine mixed salts, but there is not sufficient supply to continue to meet U.S. market demand through those producers,” the agency said in its October 12 announcement.
Last month, experts reported that production delays, regulations, overprescription, and increased demand were all playing a role in making Adderall, the popular ADHD drug and central nervous system stimulant, hard to come by.
“Last week, I needed my ADHD prescription refilled, but no pharmacy in my area had any,” Laura, a writer living in downtown Los Angeles, told Healthline in early September. “Not the big chains, not the independents. I’m in Los Angeles, not some small town.”
Among small pharmacies, more than 6 in 10 reported having difficulty obtaining the drug, according to a National Community Pharmacists Association survey of around 8,000 pharmacy owners and managers.
Teva Pharmaceuticals, the biggest seller of branded and generic Adderall, reported supply disruptions that could last into the fall.
But it’s not just production troubles among a single manufacturer that is responsible for shortages of the medication.
“In 2021, Adderall prescriptions went up to 41 million from 37 million the year before. The rise in demand has been linked to the ongoing pandemic as more people are struggling with anxiety,” Dr. Harold Hong, a psychiatrist at New Waters Recovery in North Carolina, told Healthline.
“People who take high doses of Adderall without a prescription can develop a tolerance for the drug, leading them to seek out more medication,” Hong added. “This amplifies the demand for Adderall and creates a greater strain on the supply.”
If you find yourself short on medication, you might experience an Adderall “crash,” a condition that includes symptoms such as trouble sleeping, panic attacks, depression, suicidal ideation, and sluggishness.
“It will take about 50 hours for Adderall to be entirely excreted from the body, so the average person has two days of grace,” Benjamin Gibson, PharmD, an adjunct pharmacy professor at the University of Austin in Texas, told Healthline.
“Some effects are typically more severe in those who [use] Adderall at high doses,” Hong noted. “If you cannot secure a supply of the medication, you must speak with a doctor about other treatment options and how to manage your withdrawal symptoms.”
Government regulation plays a role
Adderall and other ADHD treatments are scheduled substances that can be habit-forming, so the federal Drug Enforcement Administration (DEA) sets quotas on how much of these drugs can be produced.
The quotas the DEA sets are a projection based on current usage and sometimes aren’t agile enough to meet a sudden surge in demand.
Previous shortages have even seen manufacturers blaming the DEA directly, such as Shire Pharmaceuticals did during a shortage in 2011.
The DEA, for its part, says it has good reason to regulate these medications the way it does.
“While DEA has observed a significant increase in demand among domestic manufacturers to bring generic ADHD-products to a relatively stable domestic market, it has also grown increasingly concerned over how these market forces may impact the misuse of prescription stimulants among young adults,” the agency wrote in a statement accompanying its 2022 quota recommendations. “It is notable that major increases in diagnosis and treatment of ADHD coincide with FDA approval of various stimulants.”
Underlining this, in April 2022, the agency warned two websites accused of illegally selling Adderall online without a prescription to cease their operationsTrusted Source.
And more legitimate telehealth companies have also fallen under scrutiny, with one company, Cerebral, facing simultaneous DEA and Department of Justice investigations involving prescriptions of the drug.
That makes figuring out just how much Adderall is being overprescribed hard to establish.
“The greater availability of Adderall tablets online amid the unlawful saleTrusted Source of drugs over the internet makes it difficult to decipher how much of the drug is being overprescribed,” Hong said.
Whatever the cause, many people who use Adderall say the shortage is real.
“I called CVS and Walgreens and Rite Aid near me. They all told me they did not have it and neither did any of their other pharmacies in the area,” Laura said in early September. “I also called several other independent pharmacies and they didn’t have it either. I asked about my dosage and other dosages.”
“Then I gave up and prepared to go through withdrawal,” she said.
