A shortage of drugs to treat ADHD has turned tracking medication down into a full-time job.
By Laura Swartz·
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The nationwide Adderall shortage has been draining. / Illustration by Matt Harrison Clough
I’m walking through Rittenhouse on the way to get my daughter from school on Valentine’s Day, and I get a text from my husband, Matt. He’s leaving work early to pick something up for me. It’s going to be expensive, but it’s not unusual to have to pay a premium for something that’s hard to get, especially given the timing. I’m filled with gratitude. Flowers? Chocolates? Some sparkly jewelry? Nope: amphetamines.
Specifically, Adderall — the brand-name version. Our insurance only covers generic, which isn’t available anywhere at the moment, so it’ll cost $250 — which could buy a very nice V-Day gift, mind you. It’s a price we’re willing to pay so I don’t become a zombie who can’t do her job, much less get out of bed. Withdrawal isn’t worth it.
I know, because over the past six months, I’ve experienced intermittent days of withdrawal, despite my best attempts at planning ahead to avoid it — despite Matt and me calling dozens of pharmacies increasingly farther from Center City as my pills for the month dwindle. (With federal restrictions on Adderall, we can’t begin our search too many days in advance, because I wouldn’t be allowed to refill then anyway.) We’ve memorized the automated menus by now and hit the correct keypad choices before the robot operator can give us the rundown. One month, we found some in Bala. This month, it was a small independent pharmacy in Northern Liberties. We got lucky.
In October of 2022, the Food and Drug Administration announced a nationwide shortage of Adderall, a.k.a. mixed amphetamine salts, a drug commonly used to treat attention deficit hyperactivity disorder. The shortage trickled down to other ADHD medications as some users unable to get Adderall switched to more readily available alternatives. The result: Millions of people diagnosed with ADHD have been struggling to find their medicine for months now, and it’s taking a toll on their mental, emotional and financial health. And while some of the supply-side reasons for this crisis show signs of abating, there are larger, systemic issues that highlight how messed up this situation has been for far too long. ADHD drugs aren’t the only ones affected by kinks in the supply chain — recently, Tamiflu, amoxicillin and Children’s Tylenol, among others, have been scarce. But Adderall serves to illustrate the wider problems in the industry.
When I was growing up, in the ’90s, ADHD made me a “bad kid” — I was bored, I talked in class, I was “emotional” and “impulsive.” But like many others with the disorder, I was also identified as gifted, so while I spent many recesses standing against the wall — a truly misguided form of discipline for a hyperactive kid — I was lucky enough not to suffer academically. It wasn’t until I started taking medication, in college, that I began to fully understand I’d been playing on hard mode my whole life. While I thrived at my rigorous liberal arts college, I was met with a new form of scrutiny and suspicion — this time, from pharmacists with built-up skepticism toward those asking for the oft-abused drug.
This isn’t uncommon. Due to their addictive nature, their popularity as street drugs, and their likelihood for abuse, Adderall and similar stimulants are classified by the FDA as Schedule II controlled substances. What does this mean in practice? While non-controlled medications can be easily called in with refills — CVS can’t text me soon enough to tell me those are waiting for me at the pharmacy — you have to jump through a series of hoops to get Adderall every month.
For starters, up until a few years ago, you had to have a physical paper prescription every time you needed a refill. (Pennsylvania switched to e-prescription in 2019; it requires that doctors use a very specific electronic health record system that meets federally mandated security requirements, and there’s still no calling in a refill.) And, of course, there’s the added cost built into monthly prescriptions: ongoing visits with a therapist that can run upwards of $200 per session. For those with ADHD, the added cost goes beyond the monetary; keeping track of all those appointments and errands can take a significant mental toll.
And that’s when everything works out.
Now, there’s the added complication that your pharmacy likely doesn’t have any Adderall, so you need to call your doctor to see if your script can be sent elsewhere in hopes that place will have it, or you try to get creative with dosing or get a whole new prescription for a substitute medication. (I had to switch to a lower dose in January because that was all I could find; this also required a new prescription.)
And that’s if the pharmacy will even tell you whether it has the drug in stock. Some places have been reticent to give out this information over the phone — the risk of burglary is one reason — so you have to pound the pavement and hope. Finding illegal drugs would be so much easier than this … thanks to a system designed to combat illegal drugs.
“Half of them won’t even tell me if they have it in stock, and I give my license number on behalf of the patient,” says Center City psychopharmacologist Louis Littman, who estimates he has 125 patients on stimulants.
Littman fields constant messages from patients who can’t get their medication and need him to log into the system to send prescriptions to another pharmacy or prescribe a different stimulant. “Every day for the last nine months, I get multiple texts a day from patients all over, saying ‘This pharmacy’s out; can you send it here?’” This process in itself can cause delays — delays that mean more missed doses, more missed assignments, more falling behind.
To complicate matters, Littman tells me, switching drugs isn’t recommended for all patients, since ADHD drugs aren’t bioequivalent. For example, he says, “Adderall is a mixture of two chemicals. Vyvanse turns into one of those chemicals, but some people need both components for optimal benefit.”
The rigid regulations designed to protect us have only led to more anxiety and loss of productivity. Aside from the frustration this shortage is causing, what scares me is the utter hopelessness of it all.”(Video) Why Train Tickets Cost So Much In America
As with so many issues, the COVID pandemic is largely to blame for this current drug shortage, on both micro- and macro-economic levels. First, the pandemic shut down China, where many of the precursor chemicals for stimulants are produced. Then, in 2021, Teva Pharmaceuticals, the largest manufacturer of generic Adderall, halted production at its Irvine, California, plant due to contamination issues raised by FDA inspectors and an ongoing labor shortage.
Meanwhile, demand for Adderall and other ADHD medications has only gone up. Analytics firm IQVIA shows a recent 27 percent increase in prescriptions, from 35.5 million in 2019 to 45 million in 2022. Reasons for this are also pandemic-related. Many people with ADHD who didn’t need medication before the pandemic found they couldn’t focus as well when working from home, since structure and routine are important coping mechanisms. “It’s not that they suddenly developed ADHD; it’s that they were operating at a level that wasn’t impairing them, but then it was,” Littman explains. Another pandemic-related reason for the spike in demand: Stimulants like Adderall are prescribed as off-label treatments for long-COVID brain fog.
(Not all the COVID-related causes for increased demand are entirely negative. Because the pandemic led to an expansion of telehealth, more people were able to access mental health care than ever before — which meant more diagnoses. “People who weren’t treated in the past suddenly could get treatment,” Littman says.)
But wait; there’s more: Each year, the Drug Enforcement Administration sets an annual limit on the quantity of amphetamines that manufacturers can produce. The DEA bases these aggregate production quotas (APQ) on data from previous years — and while it claims that in the past three years, manufacturers didn’t meet those quotas, the unprecedented recent increase in demand meant the DEA’s year-over-year estimate was inadequate. “They’re not taking into account the real-world changes that have occurred with the pandemic,” says Littman. Despite evidence of the Adderall shortage in October 2022, the DEA declined to increase the APQ for 2023. Other medications, from Ozempic to albuterol, are in short supply, too. And while they don’t have the added difficulty of being controlled substances, no health-sustaining prescription should come with such uncertainty.
Robert Field, an expert in health-care regulation and professor at the Kline School of Law and Dornsife School of Public Health at Drexel, says one reason for this crisis that hasn’t been widely discussed is our health-care system’s heavy reliance on generic drugs, whose supply is actually more vulnerable to disruption. “Generic companies have fixed capacity, and they devote it to those drugs that are in demand, at the levels of demand that are prevailing,” Field says. “They can’t just flip a switch and go from drug to drug if there’s a sudden increase in demand. It might involve shortchanging other products they make.” Generic drug companies have much smaller profit margins than their brand-name counterparts, so their financial incentives to continue producing the same drugs aren’t as great, Field notes, and adds, “It would help if we could get a better handle on brand-name drug prices, to reduce the difference with generic prices. The government could also adjust the balance by increasing reimbursement rates for generic drugs under Medicaid.”
Field says the FDA should also supervise suppliers more closely and be more proactive about possible manufacturing woes and disruptions. “It’s not like an electronic gadget, where if there’s not enough supply, you can wait a few months to get your iPhone,” he explains. “This is something people need every day, so I think it’s a legitimate area for the government to be aggressively involved in.”
The cruel irony is that the people affected by the shortage are the very people who, thanks to their ADHD, lack the executive functioning skills needed to solve the monthly scavenger hunt that getting refills has become.
The rigid regulations designed to protect us have only led to more anxiety and loss of productivity. Aside from the utter frustration and waste of time this shortage is causing, what really scares me is the utter hopelessness of it all. I’ve worked so hard for so long to have everything I want, but in my darkest moments, I worry it’s all precarious — that because some factory in California had water damage, I’m going to lose everything someday. Like the spell will be broken, and my carriage will be a pumpkin again. And I know none of that’s true, but being physiologically dependent on something that’s suddenly scarce can bring out the worst thoughts. Like many people with ADHD, I already live in a rigid yet delicate balance — a measured cocktail of routine, structure, self-imposed rules, therapy and medicine. And while I’m blessed to have him, I shouldn’t also need a spouse who will scour Google Maps and call 40 pharmacies for me on Valentine’s Day.
Published as “Attention Must Be Paid” in the May 2023 issue of Philadelphia magazine.
Most psychiatrists and other prescribers have switched their patients to Adderall alternatives, such as Ritalin, Concerta, Vyvanse and Focalin when Adderall has not been available.What to do if pharmacy is out of Adderall? ›
Establish a Relationship With Your Local Pharmacy
“At large chain pharmacies, pharmacists can call around to other branches to see if they can fill your prescription. And at smaller pharmacies, the pharmacist may be able to contact distributors to see what they have on hand or are getting in,” says Dr. Sultan.
Several alternatives to Adderall show promise in reducing ADHD symptoms, including some nonstimulant ADHD meds like Strattera (atomoxetine), Intuniv (Guanfacine) and Kapvay (clonidine).Why is my Adderall not working anymore? ›
The body can develop Adderall tolerance. If you are using it for medical reasons, you may feel as though it has stopped working or become less effective after a period of time. This is perfectly normal. Usually, your doctor will evaluate the efficacy of your current dose and prescribe a tiny increase in dose if needed.What is the alternative to Adderall in 2023? ›
Mind Lab Pro, Modafinil, NooCube Brain Productivity, Performance Lab Mind, and SANE Vitaae are some of the most effective alternatives to Adderall.What to do if you run out of ADHD medication? ›
- Many chain pharmacies can search their computer system to find the medication you need at another location; in some cases, you may need to request this service in person at the pharmacy.
- If the chain pharmacies near you don't have the medication you need, try calling the independently owned pharmacies nearby.
With the right online pharmacy, you can find refills for your Adderall prescription at reasonable prices. We want to break down barriers between patients and the medications they need to live their lives with minimal side effects.Can a pharmacist refuse to fill Adderall? ›
Refusing to fill a prescription is not against the law. Pharmacists can refuse to fill a prescription for a number of reasons, including: The patient may be abusing or misusing the prescription drug. The patient may be trying to fill a prescription too early or in quantities against pharmacy law restrictions.Why is there an ADHD medication shortage? ›
Some generic manufacturers, such as Teva, have claimed it is due to a combination of increased demand and manufacturing delays, which have come in the form of labor shortages and supply chain issues.Is there an over the counter Adderall substitute? ›
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- Try something new.
- Make a list of small tasks and complete them.
- Listen to music you enjoy.
- Exercise regularly.
- Try meditation or yoga.
While Adderall itself cannot be purchased over the counter, there are alternative medications and supplements available without a prescription. These options may help improve focus and concentration for individuals who cannot obtain a prescription for Adderall or wish to avoid potential side effects.Why am I still lazy on Adderall? ›
Why Sleepiness Can Happen With Adderall. Adderall is a stimulant that boosts your levels of serotonin, norepinephrine, and dopamine. These are neurotransmitters in your brain that calm and relax you so you can focus better. They also affect sleep in different ways.What's the best manufacturer for Adderall? ›
For the BEST quality and most potent adderall on the market is made by a company called TEVA.Why can't I get hard after taking Adderall? ›
Adderall can cause erectile dysfunction as it impacts the cardiovascular system. It affects blood flow and the constriction of blood vessels which may impede your ability to develop and maintain an erection.What is the new ADHD medication like Adderall? ›
What Are the Newest ADHD Medications? Qelbree is a non-stimulant approved for the treatment of ADHD in children and adults in 2021 and 2022, respectively. Azstarys is a once-daily central nervous system (CNS) stimulant approved for the treatment of ADHD in patients aged 6 or older in 2021.Is Ritalin or Adderall better? ›
Both medications work in similar ways in the brain and have similar side effects. The primary difference is that Ritalin works quickly and reaches peak performance earlier than does Adderall, which stays in the system longer. “One molecule is not intrinsically better or to be preferred over the other,” says Dr.Can you get a 90 day supply of Adderall? ›
Depending on your coverage and the rules in your state, your doctor may be able to write up to a 90-day prescription. It may be easier if your doctor can “eprescribe.” That's a secure way to electronically send in a prescription. Some doctors don't want to write large prescriptions for these medications.Can I take ADHD medication for the rest of my life? ›
You might not need to take stimulant medication for ADHD forever; however, your ADHD is still there. If symptoms warrant it, you'll want to start taking your ADHD medication again.What is the stigma of Adderall? ›
Not only has misuse of Adderall led to its stigmatization as a drug of abuse, it can also lead to negative physical side effects, including cardiovascular complications, sleep disturbances and addiction.
A great place to start is with your primary care physician, as they can refer you to the proper practitioners if needed. If you already see a mental health provider, speak with them about your interest in finding out if Adderall can work for you.Can you still get Adderall through telehealth? ›
Schedule II substances -- such as opioids, Adderall, and Vicodin -- require an in-person visit. Schedule III through V substances can be prescribed for 30 days after an initial telemedicine visit, but then an in-person visit is required for a refill.Can I pick up someone else's Adderall prescription for them? ›
Yes, you can typically pick up a prescription for someone else. HIPAA allows a pharmacist to use their professional judgment when giving someone's prescription to a friend or relative.What's the earliest you can refill a controlled substance? ›
patient shall not be refilled before sixty-six percent of a 90 day supply has passed or fifty percent of a 30 day supply has passed, unless the practitioner authorizes the early refill, which must be documented by the pharmacist. 16.19. 20.46 PRESCRIPTION - PARTIALLY REFILLED: A.Is there an Adderall shortage in Canada? ›
Canadians who take Adderall don't have to worry about local pharmacies running out. The prescription medication is in short supply south of the border however. A shortage remains active that was first announced by the US Food and Drug Administration on Oct. 22, 2022.Can I transfer my Adderall prescription from one Walgreens to another? ›
You can do this by calling, stopping by the new pharmacy in-person, or going online (if your new pharmacy offers transfer services on a website or mobile app). If you want to take the online route, pharmacies like CVS and Walgreens have a streamlined process.Is there a Adderall shortage 2023? ›
The ongoing shortage has brought the DEA's limits on Adderall production under scrutiny. Though the current shortage was officially recognized in October 2022, the agency did not alter its plans for production quotas in 2023 in a December 2022 bulletin, to the bafflement of some outside observers.What is the most common drug used in treating ADHD is still? ›
Stimulants are the best and most common type of medication used to treat ADHD. There are only two stimulant medications, methylphenidate (the active ingredient in Ritalin, Concerta and other formulations) and amphetamine (the active ingredient in Adderall, Vyvanse and other formulations).Why are there so many cases of ADHD now? ›
Although genetics account for the majority of the risk, Strathearn points out that if we are seeing a true rise in ADHD, it seems likely that environmental factors play a role in the recent rise, “because genetics don't change that quickly,” he says, i.e. over the course of 20 years.What is the best antidepressant for ADHD? ›
- Bupropion (Wellbutrin)
- Monoamine oxidase inhibitors (MAOIs)
- Tricyclic antidepressants like desipramine (Norpramin) and imipramine (Tofranil)
- Venlafaxine (Effexor)
Low levels of dopamine can make you feel tired, moody, unmotivated and many other symptoms. Treatments are available for many of the medical conditions linked to low dopamine levels.What vitamin helps with dopamine? ›
Along with eating a balanced diet, many possible supplements may help boost dopamine levels, including probiotics, fish oil, vitamin D, magnesium, ginkgo and ginseng. This, in turn, could help improve brain function and mental health.What stimulates dopamine naturally? ›
Getting enough sleep, exercising, listening to music, meditating, and spending time in the sun can all boost dopamine levels. Overall, a balanced diet and lifestyle can go a long way in increasing your body's natural production of dopamine and helping your brain function at its best.What is the Canadian version of Adderall? ›
Methylphenidate ER Brand and Generic Interchangeability
1,12 There are two generic products currently marketed in Canada (APOTEX, Actavis); the manufacturers indicate that the APO generic is only an SR formulation while the ACT generic is a combined IR and SR formulation.
This is sometimes called the “Concerta crash” or the “Adderall crash,” after common brand names of stimulant medication. Some of the symptoms of this crash include fatigue and trouble focusing. Some people may describe this feeling as “zombie-like.”Does Wellbutrin give you energy like Adderall? ›
Unlike stimulant drugs that kick in almost immediately, Wellbutrin takes several days for most patients to notice the effects. Does Wellbutrin give you energy? With the increase of dopamine that Wellbutrin provides, some patients may experience a boost of energy and motivation while taking Wellbutrin.Is it bad to take Adderall consistently? ›
Long-term use of Adderall could lead to addiction, heart problems, slowed growth in children, or mental health issues.Does Teva still make generic Adderall? ›
Teva, which offers both branded and generic versions of the drug, has various presentations of Adderall available. However, its generic is under allocation only, amid an “unprecedented” increase in demand.What is the difference between Adderall and Strattera? ›
Strattera contains atomoxetine whereas Adderall contains a mixture of amphetamine salts (MAS). Both Strattera and Adderall are effective for ADHD; however, Strattera is not a stimulant which means it is not likely to be abused or cause dependence, tolerance, or withdrawal symptoms on discontinuation.What is the generic for Adderall? ›
The generic name for the drug in both the tablet and the capsule is amphetamine/dextroamphetamine salts. Generic drugs usually cost less than the brand-name version.