The Adderall shortage is about much more than supply and demand
“The 360” shows you diverse perspectives on the day’s top stories and debates.
For at least the past six months, the United States has been dealing with a nationwide shortage of Adderall, leaving millions of Americans unable to access a drug they rely on to focus at work, in school and in their daily lives.
The Food and Drug Administration first announced a shortage of Adderall, the most well-known of a slate of stimulant-based drugs used to treat ADHD, in October following months of reports from pharmacists and patients saying the medication was becoming increasingly difficult to come by. Supplies of other common ADHD medications like Ritalin and Concerta have also been affected.
The reasons for the Adderall shortage are complicated and poorly understood. It was first blamed on manufacturing issues at one of the main companies that makes the drug. But it’s also being attributed to a major increase in demand driven by the rapid expansion of telehealth during the pandemic and strict limits the government places on how much its active ingredient can be produced each year.
Though ADHD has historically been understood as a condition primarily affecting children, diagnosis in adults has increased dramatically in recent years. There were an estimated 41 million prescriptions for Adderall alone dispensed in the U.S. in 2021, a 10 percent jump from the previous year. Nearly all of that growth is attributed to a spike in demand from adults between the ages of 22 and 44, according to the research firm Trillian Health.
There have been numerous reports detailing how the medication shortage has left people with ADHD — whether they’re young school students or fully grown professionals — struggling to complete basic everyday tasks. Schools have reported an uptick in inattention and disruptive behavior. Some older users have experienced withdrawal symptoms after having their prescriptions abruptly cut off. There are also concerns that people who can’t access the medication legally may seek dangerous alternatives on the black market, raising the risk of exposure to deadly drugs such as fentanyl.
Why there’s debate
While the shortage is ultimately the result of an imbalance between supply and demand, experts say it highlights major flaws in the way authorities and the culture as a whole thinks about ADHD.
Many researchers and psychiatrists say society still hasn’t updated its perception of who Adderall is actually for, continuing to associate it with rambunctious school children and college students pulling an all-nighter rather than the many adults who deal with the condition on a daily basis. That oversight, they argue, has led to a severe lack of urgency within the government to solve the ongoing problem. There are also no formal medical standards for diagnosing adult ADHD, which doctors say leaves well-intended clinicians to fend for themselves and creates room for online companies to hand out prescriptions based on extremely limited patient information.
One of the main sources of debate centers around the strict rules the government has in place to protect against the dangers they pose. Stimulants like Adderall, listed as Schedule II drugs, are viewed as having “high potential for abuse” alongside cocaine and opioids. There is plenty of evidence that misuse of these medications is widespread and one study suggests that hundreds of thousands of Americans suffer from addiction to the drugs. Some experts say tight controls are needed to keep these drugs out of the wrong hands — especially in light of the explosion in mental health visits being conducted digitally.
But others say strict rules limit the availability of drugs millions of people need to live productive lives. They argue that, despite fair concerns about overdiagnosis, the reality is the vast majority of adults with ADHD receive no treatment at all for their condition. There are also fears that making it harder to get the medication through legitimate means will only drive people to the black market, likely with deadly consequences.
There’s no clear indication when the shortage will end, though it’s possible that new rules put in place by the Biden administration requiring in-person visits for stimulant prescriptions and a crackdown of online providers accused of haphazard diagnostic practices may significantly lower demand for Adderall and other drugs in the next few months.
The Adderall shortage is literally a life-and-death problem
“The United States is in the middle of a prolonged and profoundly deadly overdose epidemic. Illicit drugs are often adulterated with the powerful synthetic opioid fentanyl. Although it is far more common for heroin and other opioids to be laced with fentanyl, stimulants occasionally get cross-contaminated, too. … It’s difficult to imagine a more dangerous time for a huge population of stimulant users to suddenly lose access to their medication.” — Kate Knibbs, Wired
Cutting off people’s access to care they need is never the solution to complex health issues
“Especially in the context of our broken health care system, in which seeking care often feels like a battle royal between David and Goliath, in the form of insurance and pharmaceutical companies, limiting health care options in any way is the wrong approach.” — Laura Weiss, The New Republic
Lawmakers don’t treat ADHD as the serious condition that it is
“What’s clear now is that the status quo isn’t viable. … But precious little energy has been devoted to alleviating this slow-rolling crisis in Washington. I can guarantee that offices on Capitol Hill and throughout the federal government are packed with workers whose prescriptions have been affected, yet there have been no hearings in Congress or emergency actions from the DEA or the FDA.” — Hayes Brown, MSNBC
It’s a mistake to have law enforcement overseeing prescription drugs
“The [Drug Enforcement Administration] has had five decades to prove that it can do better than the F.D.A. in controlling potentially dangerous drugs used in medicine. It has failed. Medical experts should be in charge of regulating controlled substances, as they were before the D.E.A. was created. It would be cheaper and more effective than using law enforcement, even though funding would need to be boosted significantly to directly attack undue influence from pharmaceutical companies.” — Maia Szalavitz, New York Times
The child-centric approach to ADHD treatment leaves adults behind
“The bigger problem is that too few providers are equipped to do those evaluations in the first place. Because adult ADHD was only recently recognized, most psychiatrists working today received no formal training in treating the disorder. … The dearth of trained professionals means that many adults seeking help for ADHD are seen by providers, including primary-care doctors, social workers, and nurse practitioners, who lack the experience to offer it.” — Yasmin Tayag, The Atlantic
The lack of any real oversight means allows online “pill mills” to flourish
“A lot of us are very pro-telemedicine. We think that’s the future, but that it should be done in a way that’s compatible with best practices and health. That’s all that people are asking for. So, it just raises questions when there are models that incentivize providers to not follow best practices. That’s the concern.” — Maggie Sibley, ADHD researcher, to WHYY
Misguided fears and red tape are keeping an outdated approach to ADHD in place
“The current shortage is the result of rising demand colliding with restricted supply, with consequences for millions of patients. … The Adderall shortage could be an opportunity to change how the country at large views this condition and the medication to treat it. But institutional inertia, and the shadow of the opioid crisis, is standing in the way.” — Dylan Scott, Vox
The spike in Adderall prescriptions could mean people are finally getting the support they need
“If you go back and look at prescription practices between 1990 and ’95, the antidepressant market increased. Was that because too many people were getting antidepressants? No, it’s because there were a lot of people with major depressive disorders and anxiety disorders in the community, and they weren’t getting treated. … Be careful of interpreting increased prescriptions of medications as a bad thing. It may simply be that people with the disorder are now coming forward and getting treatment.” — David Goodman, ADHD researcher, to New York
Is there a topic you’d like to see covered in “The 360”? Send your suggestions to firstname.lastname@example.org.
Photo Illustration: Jack Forbes/Yahoo News; Photo: Jb Reed/Bloomberg via Getty Images