The Adderall Shortage – Why It’s Happening, Updates & When Will It End?
Since October 2022, the Federal Drug Administration (FDA) has announced an official shortage of Adderall and related prescription medications. According to National Community Pharmacist Association reports, 97% of independent pharmacies continue to report decreased availability into 2023. This scarcity poses significant challenges for patients with attention deficit hyperactivity disorder (ADHD) and mental health professionals.
Adderall, a brand name for the combination of amphetamine and dextroamphetamine, is widely prescribed to children, young adults, and adults for ADHD. This condition often presents symptoms ranging from hyperactivity, impulsivity, difficulty concentrating, and disorganization, all of which are mitigated with medication. Users, both with and without diagnosed ADHD, report improved focus, concentration, impulse control, listening, and even help treat some types of narcolepsy.
What Caused the Shortage?
The Adderall shortages can’t be pinned down to one cause but rather a cluster of brewing reasons that eventually made production and distribution much more difficult.
Potential Overdiagnosis
One of the first reasons is the possible misdiagnosis of Americans with ADHD. Almost 9 million people in the United States are reported to have been diagnosed with ADHD, over half of whom are medicated for the condition. While ADHD is a relatively common mental health condition, the United States has a much higher rate of ADHD and use of amphetamines than other Western countries.
It isn’t straightforward to determine precisely why the numbers are higher. Some theories point to different criteria for diagnosis and methodology, both of which can be taken advantage of, and a more accepting perception towards prescription medication and mental health.
One study showed evidence of ADHD overtreatment in children, most likely caused by giving medication to students with milder symptoms. Students with severe symptoms were likelier to show improved test scores and general well-being than those with more manageable ones. Unfortunately, by medicating each diagnosed child or adolescent, less treatment may be available for those who need it the most.
Illicit Use
Illicit use is commonly practiced by high school and college students or people with high academic or work-related stress. The drug can assist users in gaining energy, focus, and concentration to complete tasks. However, taking Adderall without ADHD or narcolepsy can lead to anxiety, jitteriness, dizziness, and even heart attack and stroke if abused for long periods.
Even though illicit use isn’t a direct cause of the Adderall shortage, it certainly contributes to the problem. When non-prescribed users take the drug recreationally, they contribute to its rising demand. They do this by falsifying symptoms to get prescriptions or buying them from others who have prescriptions. The higher the demand, the less medication is available for those in genuine need.
Officials have tried to combat this problem by making it harder to get a prescription. However, this can potentially block patients with attention disorders who may not meet new criteria. It can also lead to arrests and confiscation of illegal pills, making the dealers work even harder to obtain new drugs and disrupting the supply chain, impacting prescription medication availability. While cracking down on unlawful sources is generally helpful, logistically, it can also cause further problems in the short term.
Supply-Chain Problems
The creation and distribution of Adderall includes many steps. First, manufacturers must obtain the four main ingredients: D-amphetamine saccharate, D-amphetamine sulfate, D,L-amphetamine sulfate, and D,L-amphetamine aspartate. Then, they manufacture the drug, make quality and safety checks, sort inventory logistics, and distribute the medicine to pharmacies worldwide.
Various logistical issues appear to be the main reason behind the Adderall shortage. Some extended-release tablets have been discontinued, and some manufacturers have problems acquiring active ingredients. Sadly, a lack of transparency in the supply chain process has made the extent of these issues unclear.
For example, the active ingredient in Adderall is most often produced in East Asia. However, the FDA does not have complete supervision over foreign production and cannot pinpoint the exact culprit. Unfortunately, this leaves medical professionals and patients at the mercy of these companies without much recourse or resources to help.
COVID-19
During the pandemic, many new users of Adderall logged on to telehealth services to gain access to the drug. In fact, there was an increase of more than 10% during 2020 and 2021. Some suggest that the changes in policies have led to overdiagnosis and prescriptions. However, many people also sought mental health support during the pandemic due to decreased well-being and a highlighted public focus on the subject. Both have created higher market demand for the drug.
Patient Challenges
Sadly, the effects of this shortage will fall heavily on those who need it most. Once prescriptions have been halted, some patients will have to either switch drugs or face withdrawal symptoms.
Quick withdrawal of Adderall in people diagnosed with ADHD can lead to depression, fatigue, anxiety, and a return of their ADHD symptoms, including lack of concentration and irritability. Not only does this impact their overall mental health, but it can lead to a decrease in performance, affecting school, daily activities, work, and even relationships.
Current State of Affairs & Potential Solutions
The FDA has posted a list of manufacturers and products available during the shortage and stated that they will continue to update their webpage with new information.
As devastating as the shortage is for users, it may have some positive effects in the long term. For example, it has highlighted some of the weak areas to correct in pharmaceutical production, which may lead to improved manufacturing practices.
Some solutions include new regulatory methods like expedited approvals for generic medications, improved supply chain communication across providers and agencies, pinpointing pharmacies in most need for expedited deliveries, development of new treatment strategies for ADHD and other common mental health conditions, and creating detailed emergency plans for further shortages of Adderall and other popular medications.
Overall, while the Adderall shortage is complex, there are many strategies to help patients, pharmacies, and companies adapt and improve circumstances. If you are personally affected by this shortage, it’s essential to contact your mental health team and find the best alternative plan while staying informed about when your prescription or suitable alternatives are available.
Sources:
- https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall
- https://www.psychiatrictimes.com/view/the-rx-crisis-the-impact-of-ongoing-adhd#:~:text=1-,According%20to%20the%20National%20Community%20Pharmacists%20Association%2C%2097%25%20of%20independent,of%20Adderall%20in%20early%202023.&text=Other%20generic%20amphetamine%20mixed%20salts,and%20December%202023%20(Table).
- https://www.addrc.org/2023-adhd-statistics-at-a-glance/#:~:text=An%20estimated%208.7%20million%20adults,continued%20ADHD%20symptoms%20into%20adulthood.
- https://www.pharmaceutical-technology.com/comment/commentis-adhd-an-american-disorder-5726770/:~:text=It%20is%20difficult%20to%20determine,diagnostic%20criteria,%20and%20case%20identification.?cf-view
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2778451#:~:text=We%20found%20evidence%20of%20overdiagnosis,benefits%20of%20diagnosis%20and%20treatment).
- https://www.statnews.com/2023/04/14/adderall-shortage-adhd-medication-supply-chain-transparency/
- https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a1.htm?s_cid=mm7213a1_w
- https://www.pbs.org/newshour/health/a-perfect-storm-led-to-an-adhd-medication-shortage-heres-why
- https://worldpopulationreview.com/country-rankings/adhd-rates-by-country
