The country’s supply of Adderall, a stimulant commonly used to treat symptoms of attention-deficit/hyperactive disorder (ADHD), is falling short of demand, as both patients and pharmacists have reported shortages. In fact, a recent survey from the National Community Pharmacists Association found that more than six in 10 small pharmacies report having difficulty obtaining Adderall. Teva Pharmaceutical Industries Ltd., the largest supplier of Adderall in the United States, has reported “supply disruptions” due to “packaging capacity constraints” affecting both branded and generic Adderall. Still, the FDA has not announced an Adderall shortage. However, Howard Weeks, MD, chief medical officer at Pathlight Mood and Anxiety Center, says he’s spoken with the American Society of Health System Pharmacists, who maintain a list of medication shortages in the US Adderall and its generic versions are on that list, and ASHP says they’re monitoring it. “What gets really complicated in the world of pharmaceuticals is who is actually producing the pills,” Weeks says. “Oftentimes a manufacturer subcontracts with another manufacturer to make a medication thus if one producer has a problem it can have ripple effects across many companies. The short answer is we just don’t know. There are estimates that things will improve in September/October.”
Examining Overprescription
Neuroscientist and founding CEO of SyneuRx Guochuan Emil Tsai, MD, PhD, notes that Adderall is currently being prescribed more than ever. According to Bloomberg reporting, amphetamine sales surged more in the second quarter of 2021 than they had in nearly a decade. And when demand increases while supply stays the same, we’re left with a shortage. “Prior to the unprecedented surge of diagnoses during the pandemic, ADHD has been historically underrecognized as one of the most common neurodevelopmental disorders of childhood that often lasts well into adulthood,” Tsai says. Some attribute this increase in diagnoses to social media, as more people are being exposed to symptoms of ADHD through apps like TikTok and Instagram. When those symptoms resonate with someone, they’re likely to turn to their primary care doctor for medication, Tsai says. But this has created an entirely new issue. “When a patient seeks medication from their provider, the provider may not always take into account the context of the patient,” Tsai says. “They may not have the training nor the understanding that ADHD does not exist in a vacuum. It can often coincide with substance abuse, bipolar disorder, anxiety, depression, etc.” Tsai also notes that online mental health care start-ups, many of which popped up during the pandemic, have made medication more accessible than ever. And Teva representatives have reported a direct link between the increase in demand for Adderall and these mental telehealth companies. “During the pandemic, relaxed rules requiring that patients see a provider in-person before the controlled substance can be prescribed may very well be a contributing factor to overprescription,” Tsai says. One such telehealth service, Cerebral Inc., is now under investigation by the U.S. Department of Justice for its prescription practices of substances like Adderall and Xanax. The service, which offers therapy and counseling for numerous mental health conditions, as well as medications for those conditions, has since paused all prescriptions for new users. But in just two years, Cerebral has already registered more than 200,000 patients. Former employees of Cerebral allege that the company prioritized profits over patient safety by overprescribing medications, providing little to no actual counseling, and targeting new customers with misleading social media ads. This level of wrongdoing may be unique to one company, but it’s representative of a lack of adequate care when it comes to mental health—especially for those who are most vulnerable. “It’s crucial for young patients to seek out psychiatrists or child psychiatrists for their diagnoses,” Tsai says. “They should look for providers who diagnose holistically based on clinical science, with understanding, with empathy and with discretion.”
Coping Through the Shortage
For those affected by the shortage, it’s possible to experience symptoms of Adderall withdrawal. The “crash” typically occurs within several hours of the last dosage and can continue for up to two days. Symptoms can include mental and physical exhaustion, as well as feelings of depression. Tsai recommends speaking with your doctor or another specialist to discuss medical alternatives, as Adderall and its generic versions are not the only options for managing symptoms of ADHD. “Adderall can have undesirable side effects and abuse potential, which is why many people turn to safer, natural alternatives or non-pharmacological therapy,” Tsai says. Experts also recommend drinking plenty of fluids, eating healthy meals, getting some exercise, and giving yourself time to rest and recuperate if you’re experiencing withdrawal symptoms. Over-the-counter painkillers and sleep-aids can also provide some relief.
