Briefing

How did the U.S. find itself in an Adderall shortage?

The many factors at play, and what it means for patients who rely on the drug.

The United States is experiencing a nationwide shortage of Adderall, a stimulant used to treat attention deficit hyperactivity disorder (ADHD). Demand for the medication has surged over the last few years, leaving some to question if clinicians are overdiagnosing the condition. What is the root of this shortage, and how are patients coping?

Here's what you need to know about America's Adderall shortage: 

What is causing the shortage of Adderall?

In October, the Food and Drug Administration confirmed a nationwide shortage of Adderall. The FDA website shows that the deficit continues, although some drug manufacturers have an available supply. Teva Pharmaceuticals, one of the major producers of Adderall, had issues hiring enough staff over a year ago, which led to manufacturing delays. A representative from the company told the Times that Teva had resolved its staffing issue, but now faces "a surge in demand," leading to an increase in backorders. 

Danielle Stutzman, a psychiatric pharmacist, said that at the beginning of the COVID pandemic, regulations around prescribing controlled substances were relaxed. New rules allowed doctors to prescribe stimulants online without an initial in-person evaluation, per the Times

Several online therapy start-ups began heavily advertising their ability to diagnose ADHD on social media platforms like TikTok and Instagram, the Times reports. One such company, Cerebral Inc., promised quick and accessible access to psychiatric care and prescription medicine entirely online. In May, the company received a grand jury subpoena from the U.S. attorney's office after reports clinicians were being pressured to prescribe stimulants prompted an investigation.

A representative from the FDA said the agency expects the supply issues to be resolved in the next 30 to 60 days, per the Times. In the meantime, the agency suggests patients affected by the shortage speak to their doctors to explore alternative options to cope with the disorder's symptoms.

How have ADHD diagnosis trends changed in recent years?

The rate of Adderall use in the U.S. has been on an upward trend for the past two decades, The New York Times reports. Between 2006 and 2016, prescriptions for stimulants to treat ADHD multiplied by 2.5. Health research firm IQVIA found that 41.4 million Adderall prescriptions were filled in 2021, a 10 percent increase from the previous year, per Axios.

Many adult women have been diagnosed with ADHD in recent years. During a conference for psychiatric nurses, Pamela Wall, Ph.D., named implicit bias as one of the main reasons women tend to be diagnosed later in life. Wall also mentioned that an increased understanding of the disorder has allowed for more adult diagnoses. The Centers for Disease Control and Prevention found that between 2005 and 2013, the percentage of "privately insured reproductive-age women" filling prescriptions for ADHD medicines rose 344 percent. 

Margaret Sibley, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, told the Times that over the last few decades, ADHD medication had been marketed more aggressively by pharmaceutical companies. The ads have led to an increase in adults identifying with the symptoms and subsequently seeking treatment for ADHD. 

How are patients coping with the Adderall shortage?

As the medication continues to be inaccessible or inconvenient to obtain, experts are warning that the shortage could lead to a public health crisis. Many people taking Adderall rely on the medication daily and may be unprepared to lose access to it unexpectedly.   

Experts say that not all patients who stop taking Adderall experience withdrawal. Unfortunately, however, some people can face a host of symptoms, including "mood swings, irritability, appetite suppression and, in severe cases, suicidal thoughts." Some patients have turned to rationing their pills or driving hours away to find a pharmacy that carries them. 

Experts also warn that some people could turn to illicit drugs or unregulated sources to self-medicate, which could lead to an increase in overdose cases, Wired reports. Leo Beletsky, an epidemiologist, told Wired, "If you have lots of people moving at the same time from the pharmaceutical market to the illicit market, lots of bad things can happen. Conditions are very much ripe for that to happen here."

In an opinion article for the Los Angeles Times, Dr. Beletsky warned that the country is "facing a real possibility of a public health disaster on a scale not seen since the prescription opioid crisis that began a decade ago." He says the Adderall shortage poses a similar threat: "For those losing adequate access to prescription amphetamine, illicit alternatives — especially methamphetamine — are readily available."

Doctors believe the response from government agencies and public health leaders has not been urgent enough. Primary care physician Eric Kutscher, who has researched stimulant use disorders, argues the FDA needs to provide better guidelines for alternative care that doctors can offer their patients. 

"There should be no reason that a patient who was previously stable on Adderall doesn't get some sort of replacement therapy, whether it's another short-acting stimulant or a long-acting stimulant that can tide them over and provide at least some degree of symptomatic support," he told Wired.

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