An ongoing shortage of medications prescribed to treat attention-deficit/hyperactivity disorder or ADHD, such as Adderall, has left many patients struggling to get the treatment. More than one year into the shortage, there seem to be more questions than answers.
Millions of children and adults in the United States are prescribed medications to treat ADHD, a neurological disorder which causes differences in the brain that affect executive functioning.
In October 2022, the U.S. Food and Drug Administration announced a shortage of the immediate-release formula of Adderall due to a manufacturer delay. A year later, the shortage persists and now affects several of Adderall’s generic equivalents and other stimulant ADHD medications, frustrating patients, providers and pharmacists.
What is Adderall? How does ADHD medication work?
ADHD is often treated with medication. One of the most popular is mixed amphetamine salts, also known by the brand name Adderall. Adderall and its generic versions are part of of a class of drugs called stimulants, the most common type of prescription medication doctors use to treat ADHD, according to Cleveland Clinic.
ADHD medication works by increasing levels of neurotransmitters in the brain called dopamine and norepinephrine, per the Cleveland Clinic. This helps to reduce ADHD symptoms, including trouble focusing, executive dysfunction, impulsivity and hyperactivity.
"What the meds do is analogous to eyeglasses," Dr. Ned Hallowell, child and adult psychiatrist and ADHD expert, tells TODAY.com. "Eyeglasses don't make you smarter, but they do dramatically improve your ability to use the smarts you've already got."
The shortage has left many people with ADHD unable to get the medication they need, forcing them to switch to an alternative or go off medication as a result.
"It's made people desperate and panicked. ... It can really cost them mileage at work and impair their relationships," says Hallowell.
Unmedicated children may struggle to learn and regulate their behavior in class, Dr. Warren Ng, a child, adolescent and adult psychiatrist at Columbia University Irving Medical Center, tells TODAY.com. Grades and self-esteem suffer as a result. "In the end, the kids internalize it," he adds.
Since the shortage began, Ng says he has seen children miss days of school and college students take semesters off to cope. It's also taking a toll on parents, who often spend hours going from pharmacy to pharmacy to find their child's medication, says Ng.
The stimulant shortage has compounded what Ng calls an ongoing pediatric mental health crisis, accelerated by the pandemic.
Why is the shortage happening, when will it end, and what are some alternative options for those who can't get their medication?
Why is there an Adderall shortage?
The current shortage of Adderall and other ADHD medications is now driven by too much demand and not enough supply, an FDA spokesperson tells TODAY.com.
Initially, the shortage of immediate-release Adderall (Adderall IR) announced in October 2022 was caused by "ongoing, intermittent manufacturer delays" at Teva Pharmaceuticals, one of the biggest distributors of Adderall in the U.S., according to the FDA. (Teva Pharmaceuticals did not respond to TODAY.com's request for comment).
Since then, "other manufacturers (have continued) to produce amphetamine mixed salts, but there is not sufficient supply to continue to meet U.S. market demand through those producers,” the FDA said in an August 2023 announcement.
As of Oct. 25, the following medications are in shortage, according to the FDA's database:
Generic amphetamine mixed salts IR
These include 40 different formulations and dosages of Adderall and its generics, according to an Oct. 18 report from the American Society of Health-System Pharmacists.
At least seven manufacturers still have some availability of Adderall IR and its generics, according to the FDA, while others estimate that more supply will become available between October 2023 and February 2024.
Extended-release Adderall (XR) and its generics are not currently in shortage, the FDA spokesperson says, but these medications are being “monitored closely.” However, some manufacturers of Adderall XR are still affected by earlier supply issues, per the ASHP.
The FDA says it is working with drugmakers to increase supply to meet demand, but many frustrated patients and providers are wondering: Why is it taking so long?
Unprecedented demand driven by an increase in prescriptions is one factor, Amanda Nguyen, Ph.D., a health economist with digital health care platform GoodRx, tells TODAY.com. Data show that, from 2012 to 2021, there was a 45% increase in the dispensing of stimulants, per the FDA.
"There’s been an uptick in ADHD diagnoses, and that can be for a number of reasons ... reduction in stigma, more awareness around ADHD,” says Nguyen. Pandemic-era policies allowed for greater access to telemedicine, she adds, which may have made it easier for some people to get ADHD medication prescriptions.
In 2021 alone, the number of Adderall prescriptions dispensed jumped to 41.4 million, up by 10.4% from 2020, according to IQVIA, an analytics provider for the life sciences industry, NBC News reported.
But demand is not the only reason the shortage has persisted, the experts note, and federal agencies and manufacturers seem to be blaming each other in recent months.
Stimulants are controlled substances due to their potential to be abused, which means the Drug Enforcement Agency sets limits on how much of the drug can be produced. However, the FDA has found that many manufacturers are still producing below their allotted amounts, Nguyen says.
On Aug. 1, 2023, the heads of the FDA and DEA released a joint letter calling on drugmakers to confirm they are working to increase production of stimulants. “Manufacturers only sold 70% of their allotted quota, and there were approximately one billion more doses that they could have produced but did not make or ship," FDA and DEA officials noted.
Teva Pharmaceuticals and Sandoz, two of the largest producers of ADHD medications, told NBC News that they used 100% of the DEA quota allotted to them in 2022 and requested quota increases.
The FDA and DEA have asked companies that do not plan to increase production to give up their remaining 2023 quota allotment for stimulants so the DEA can redistribute it to other manufacturers.
Shortage of other ADHD medications
The increased demand and shortage of Adderall and its generics has had a domino effect. Now, long- and short-acting forms of other stimulants used to treat ADHD are in limited supply too, NBC News previously reported.
As of Oct. 25, there are shortages of various brand-name and generic versions of amphetamine-based and methylphenidate-based medications. Check the FDA and ASHP websites for the latest information about current and resolved drug shortages.
Prior to the nationwide shortage, about half of the fills for ADHD prescriptions were for Adderall or its generics, says Nguyen. One year later, the heightened demand for stimulants has caused Adderall fills to dip while other ADHD medication fills have risen, according to GoodRx data.
“The supply shortage has spilled over to other manufacturers and alternatives that people are turning to,” says Nguyen.
The FDA approved the generic version of Vyvanse for the first time in August 2023. In the few months since its approval, fills have surged, outnumbering those for brand name Vyvanse, per GoodRx data. Now, both Vyvanse and its generics are in short supply.
“People end up getting into this scarcity model of trying to chase what’s available this month, and that creates immediate shortages of different medications,” says Ng.
The combination of increased demand, manufacturer supply issues, and production quotas has created a perfect storm, experts note.
When will the Adderall shortage end?
The Adderall shortage will end when supply meets demand, the experts note, but this isn't as easy as making more medication; simply put, there's no clear timeline as to when all ADHD medications will be readily available to those who need them.
The FDA cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug, Chanapa Tantibanchachai, a press officer for the FDA, tells TODAY.com.
It's unclear whether the DEA will change the quotas on stimulant production or its approval process for increasing quotas, but some stimulant manufacturers have already requested increases from the DEA, NBC News previously reported.
Earlier this month, Congress got involved. In an Oct. 12 letter, Democratic lawmakers pressed the FDA and DEA for more answers about their efforts to end ADHD medication shortages and urged the agencies to work with manufacturers.
“The FDA recognizes the potential impact that increased demand of certain products may have on health care providers and patients,” says Tantibanchachai."The public should rest assured the FDA is working closely with numerous manufacturers, agencies and others in the supply chain to understand, mitigate and prevent or reduce the impact of increased demand of certain products."
"It feels like a moving target. ... It's created almost a mob mentality around (which medications) are available," says Ng.
In the meantime, people may have to pay out of pocket for whatever is available at the pharmacy. Although brand name drugs and their generics are therapeutic equivalents, says Nguyen, insurance plans may cover only cover the generic.
Fortunately, people who can't access Adderall or other ADHD medications still have alternative options.
If you can't get Adderall, talk to your doctor about alternative medication options or dosages, the experts emphasize. "There are about a dozen other drugs you can try ... and we can usually find another one that works instead of going cold turkey," says Hallowell.
According to the Child Mind Institute, ADHD may be treated with the following medications and their generic equivalents (in either immediate-release and extended-release formulations):
Amphetamine-based: Vyvanse, Dexedrine, Dynavel XR, Adzenys XR-ODT, Mydayis, Evekeo, Zezedi, and others.
Methylphenidate-based: Concerta, Ritalin, Focalin, Methylin, Daytrana, Relexxii, Quillivant XR, and others.
Non-stimulants work differently than stimulants and are not controlled substances, which make them easier to prescribe, says Hallowell. These include:
Non-stimulant medications are recommended for the 15-30% of children with ADHD who don't respond to stimulants, per the Child Mind Institute. They may also be a good option for children who experience negative side effects from stimulants, experts note.
It's also important to integrate behavioral modifications — including therapy and ADHD coaching — to improve symptoms, says Ng. While these interventions are most effective when combined with medication, patients should try to continue these even if they have to go off medication, the experts emphasize.
CORRECTION (Oct. 31 2023, 1:48 p.m.): An earlier version of this article misstated that brand-name drug Concerta was in a shortage at the time of publishing. While several generics (methylphenidate hydrochloride extended-release) are in shortages, branded Concerta is currently available, a spokesperson for Janssen told TODAY.com. This article has been updated to provide resources to find the most up-to-date shortage information.
This article was originally published on TODAY.com