October 17, 2023
Author: Lynsey Grzejszczak, MHA
For over a year, the United States has been facing a shortage of Adderall, a stimulant medication popular for the treatment of attention-deficit/hyperactivity disorder (ADHD). This shortage has impacted 141 different formulations of common stimulant ADHD medications, including Concerta, Ritalin and Vyvanse. The result is either a low supply of these medications or a complete lack of it, resulting in the estimated 6 million children and adolescents and 8.7 million adults diagnosed with ADHD without access to medication that allows them to function at the considered normal baseline.
As an adult with ADHD, this is not just a public health issue, but a personal issue and something that I have been dealing with for months. In this blog, I want to highlight the complexities of the ADHD medication shortage and solutions to address this problem.
How Did We Get Here?
There are three potential causes for this medication disruption: 1) the manufacturer not using their allotment of the controlled substance found in stimulants, meaning they didn’t make the full amount of drugs they are permitted to make, 2) limitations on drug production to meet demands, and 3) the rise in access to prescriptions due to telehealth, with an almost 10% increase in stimulant prescriptions from 2020 to 2021.
Impact of Lack of ADHD Medication
Studies show that adults with ADHD are more likely to die earlier by unnatural causes, such as car accidents, than their non-ADHD counterparts. Those with ADHD are also more likely to have adverse health outcomes, including obesity, diabetes, sexually transmitted infections and insomnia. Relationships, including romantic, platonic, and familial, can be strained due to behaviors and emotional dysregulation.
On a personal level, since a recent move to New Hampshire, I have gone four months without access to the medication that allows me to focus on my work, my friends and family, and the things I love. My fiancé has noticed a change in my behavior, with work leaving me exhausted from extra effort to remain focused. Previous to the shortage I was reading a book a week, a hobby I thoroughly have enjoyed since my youth. Now, I have a pile of books that sit waiting for me to be able to have the mental capacity to read again.
I’ve spent countless hours calling pharmacies and traveling long distances in an attempt to pick up a prescription, all to be met with frustration and disappointment when inevitably no medication is to be found. Licensing laws also mean I cannot travel back to my home town in Connecticut, or even across the border to Vermont or Massachusetts, to pick up my medications. I’m left anxious thinking about all those I perceive that I’m letting down due to something that is far out of my control.
The solution for this medication shortage is not cut and dry. There’s been a call to limit or stop the use of telehealth for prescribing ADHD medications, though a recent study from EPIC Research shows that prescribing habits do not change based on visit modality. This call to remove a tool which has proven to be a facilitator of accessing healthcare means that an effective care tool is being taken away from patients, especially those who lack access to mental health care due to location or other factors. My psychiatric medication prescriber is over an hour and a half drive away from where I live. Monthly trips for an in person visit, as stimulants can only be given in 30 day increments, will mean almost 4 hours away from work a month in order to try to get this prescription. In a year, that’s 48 hours spent on the road and in appointments to live a somewhat neurotypical life.
The FDA also recently approved a generic for Vyvanse, which many report should help alleviate some of the stress on the medication demand. But, Vyvanse is one of the more expensive ADHD medications so the attainability to all may be limited, and even with this new option, supplies may run out fast. The solution that I’ve been using in the interim is changing my routines to better support my needs. Timed caffeine consumption and exercise have helped to alleviate some of the symptoms, but nothing will fully replace my medication. I’ve started to use fidgets in meetings to help, as well as taking up knitting to keep my hands busy and help quiet my mind. However, these are not blanket solutions for everyone out there, just ones that I’ve found work for me.
From a policy perspective, there are actions Congress can take to address the shortage of ADHD medication. The FDA is responsible for handling drug shortages; however, because ADHD medication, specifically Adderall, is a Schedule II controlled substance, the Drug Enforcement Administration (DEA) also provides regulation of Adderall, thus adding another layer of complexity to this already complex issue. Senator Ron Wyden (D-OR) has been raising the alarm about the shortage of ADHD medication, citing that he has received conflicting messages regarding who is to blame for the shortage with the DEA, FDA, and drug manufacturers all pointing the finger at each other. Regardless of who is to blame, people’s lives and livelihoods are at stake and Congress must act now to hold the FDA, DEA, and drug manufacturers accountable. The Congressional Research Service has listed actions Congress can take, such as enhancing drug manufacturer’s reporting requirements, including increasing penalties for drug manufacturers that fail to report disruptions in drug production, and incentivizing production of drugs that are in shortage and manufacturers to invest in new technologies to help develop and maintain manufacturing best practices.
While I am comfortable disclosing something that impacts my daily life, especially something that can carry stigma, not all who have ADHD are willing to share with employers or others in the professional setting, so it’s important to give grace to those you may notice struggling.
Until there is a definitive solution to this shortage, I, and all those with ADHD, will continue on trying to function to the best of our ability and hope a solution comes soon.