unpacking the adderall shortage
Reporter Andrew Zuker looks at the local impact of nationwide ADHD medication shortages.
Why are millions of Americans with ADHD struggling to get the medications we need to function in daily life?
Image by Andrew Zuker
I, along with about 10 million other Americans, rely on a daily medication called Adderall to manage the symptoms of ADHD. I’m also one of millions whose treatment and lives have been upended by an ongoing national shortage of Adderall and similar drugs.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a developmental disorder of the brain that causes both children and adults to have difficulty with focus, impulse control, task completion, emotional regulation and self control.
ADHD is often thought of as a childhood condition, but in recent years more adults have sought treatment as a better understanding of the disorder has become more widespread.
Like many people diagnosed with ADHD in adulthood, I had avoided screening and diagnosis for years based on a misunderstanding of ADHD, and a cultural stigma leftover from my childhood in the 1990s in which ADHD was considered an excuse for bad parents to drug their children rather than raise them.
In 2022, at 39 years old and returning to college as a freshman, I found that I had no trouble understanding the material I was learning in class, but I was having extreme difficulty starting, finishing, and organizing all my weekly tasks. I lost hours of homework time feeling incapacitated and then finishing everything in a panic at the absolute last second.
In speaking with my psychologist during the screening process, it became clear that I had exhibited a constellation of ADHD symptoms for my entire life, including disordered eating, sensitivity to sound, hyperfixation, impatience, inability to sit still, interrupting others, hypervigilance, etc.
What is Adderall and why do ADHD patients need it?
Adderall and its generic versions are central nervous stimulants that work by increasing levels of important neurotransmitters in the brains of people with ADHD, which helps us regulate our thoughts and behavior, improving focus and executive function.
For me, a moderate dose of extended release Adderall improves my concentration, my eating habits, my physical coordination, my attention span, my patience, my ability to think clearly, and my ability to start and complete tasks and projects. The medication gives me a sense of control over my mind and body that was out of reach for me before.
A main ingredient of these medications is methamphetamine, a controlled substance that creates a stimulant high for people who do not have ADHD. This can lead to addiction and abuse. For this reason, the supply of Adderall and other methamphetamine based treatments are strictly regulated by the federal Drug Enforcement Agency (DEA).
What is causing the Adderall shortages?
During the early months of the Covid-19 pandemic, the main domestic manufacturer of Adderall, TEVA Pharmaceutical Industries, began to have production problems due to a shortage of workers. This reduction in the supply of the drugs coincided with a dramatic increase in both child and adult diagnosis and treatment of ADHD.
The significant uptick in diagnosis and prescription of amphetamine based medications was largely facilitated by telemedicine apps which allowed patients to connect with a provider remotely, avoiding an in-office visit.
In spite of the rapidly increased demand for Adderall, the DEA has been slow and reluctant to increase the legal quota for drug manufacturers, citing potential for abuse and addiction.
In essence, limited manufacturing quotas, staff-based production delays, and a large increase in demand have combined to create a desperate situation for people unable to reliably get the medication we need.
How the Adderall Shortage Affects Us:
Everything about the shortage has been stressful for me and millions of other people with ADHD. Facing the prospect of running out of medication, many of us have rationed our pills, taking them only when we absolutely need to be our most functional. Interruptions in treatment can cause the ADHD symptoms to return with a ferocity, leaving us feeling more dysfunctional than we did before beginning treatment.
In an attempt to maintain some program of treatment, my doctor and I met more frequently, at my expense, and tried different dosages, delivery methods, and types of medication based upon what I could track down in Reno. The rapid switching of medications caused some unwanted side effects like depression, anxiety, and inconsistent ability to function.
It has been stressful calling around to different pharmacies in an attempt to find Adderall, then relaying info to my provider and hoping to get the prescription sent in before the pharmacy sells out of that dosage. At times pharmacists have treated me with suspicion, interrogating me about my doctor and condition.
In my own experience searching for my medication in the area, I’ve found that Walgreens will no longer fill prescriptions for Adderall made through telemedicine. Raley’s Pharmacy, as well as the few local small pharmacies, cannot get any supply of Adderall for the indefinite future. CVS is moving away from distributing controlled substances like Adderall after paying hefty settlements for over-prescribing opioid painkillers like Oxcontin.
As far as I have found, Costco is currently the only reliable source for these medications in Washoe County.
What happens from here?
While the current supply and distribution of Adderall is beginning to stabilize, the manufacturing quotas set by the DEA will not be reviewed again until the beginning of 2024, which could proliferate the disparity between supply and demand.
For rural patients, and those of us in places like Reno where there is a notable shortage of medical providers and long wait times for appointments, the ability to connect online with a doctor through telemedicine is nearly the only way to access treatment and renew our prescription monthly.
On May 11 this year, as the Biden Administration allows the Covid-19 Emergency Declaration to expire, the White House plans to change the rules for the prescribing of controlled substances, requiring at least one in-person visit per year to be on file for telemedicine patients.
This could mean that many Americans will continue to experience interruptions in treatment due to difficulty finding a local doctor, even if supply issues and manufacturing quotas ease.
For now my situation has stabilized. I’m back on the dosage that works the best for me and hopeful that I can reliably fill my prescriptions again. Searching around town for medication was stressful and humiliating. Rapidly switching dosage and delivery and even trying a totally different medication made me feel depressed and disjointed, and it interrupted my progress on the overall journey of ADHD treatment, which for me includes a lot of habit-building, self-reflection, physical fitness routines, diet, and nurturing of relationships.