Matt Ford was diagnosed with ADHD, or attention-deficit/hyperactive disorder, in elementary school. He has been taking Adderall ever since.
“When I’m not medicated, it is life changing,” Ford, a journalist for The New Republic in Washington, D.C., told VICE News. “It has an impact on my quality of life. My family notices it, my wife notices it, my friends notice it. It has a measurable impact on how I’m able to function.”
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But Ford, like many Americans who’ve been prescribed Adderall to treat ADHD, has run into a deeply frustrating problem in the last several months: He can’t actually get his prescription filled, and like everyone else in his position, he can’t get a straight answer about why. In March, he took to Twitter to vent about his experience.
“I’ve spent all day calling every pharmacy near me in DC. They’re all out,” Ford tweeted. “No idea when it’ll be back in stock. No idea where I can find a place that might be able to help. I run out later this week. Without going into specifics, my quality of life is about to get a lot worse.”
And Ford considers himself one of the lucky ones. Since at least last August, there has been a national shortage of Adderall, often sending patients on a wild goose chase and frustrating providers and pharmacists alike. What’s worse is that, while the federal government and the corporations involved in the drug’s manufacturing and distribution first blamed labor shortages and then an increase in demand, neither has pinpointed why the shortage is happening, when it’ll be over, or how to prevent the next one.
Adderall, also known as mixed amphetamine salts (MAS), is one of the most commonly prescribed medications for ADHD. In October, the Food and Drug Administration announced that there was a shortage of Adderall, because the drug’s largest supplier, Teva Pharmaceuticals, was experiencing manufacturing delays.
At that point, as Motherboard reported prior to the announcement, the shortage had been going on for months; Teva and three other companies put extended-release Adderall on backorder last August, citing a labor shortage. The American Society of Health-System Pharmacists (ASHP) first listed a drug shortage for Adderall on its website last July. The FDA’s list of shortages shows that the drug is “currently in shortage,” and a list of nine companies that produce Adderall and MAS shows that just three have a fully available of all dosages they make. Regarding Teva specifically, the FDA says that the company “continues to experience unprecedented increase in demand.”
And though Teva at first said the shortage would resolve by the end of 2022, it hasn’t ended. In a statement to VICE News last week, the FDA said the shortage is now “demand-driven.” There has been a spike in ADHD diagnoses over the past several years; prescriptions for people between the ages of 22 and 44 increased nearly 60 percent between 2018 and the first half of 2022, according to Trilliant Health, a company that analyzes healthcare data.
Dr. Erin Fox, an associate chief pharmacy officer at University of Utah Health, which compiles drug shortage data for ASHP, told VICE News that a manufacturing issue alone could produce a snowball effect that makes it more difficult to obtain medication.
“If one company has a large market share, and that company has a shortage or sudden manufacturing delay, it really puts pressure on the other companies, and they may not be able to make up the difference,” Fox told VICE News Tuesday. “It’s not always easy for these companies to ramp up supply quickly.”
The Drug Enforcement Administration (DEA) did not respond to a request for comment from VICE News. The FDA told VICE News last month that the agency “recognizes the impact” the shortage “may have on health care providers and patients,” and that the shortage is now not due to manufacturers, but rather “demand-driven.” The FDA also said that “supply is increasing.”
“While the agency does not manufacturer drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug, 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 intermittent or increased demand of certain products,” the agency said in a March 22 statement.
But for the people prescribed Adderall, the lack of publicly available information about the shortage or its source has only compounded the frustration.
“Part of the frustration has been I don’t really know where to apply that sort of energy and pressure and focus,” Ford said. “I would hope that the people who are making the decisions that are responsible for this, understand that this is a drug that has serious consequences for people’s quality of life.”
“I would hope that the people who are making the decisions that are responsible for this, understand that this is a drug that has serious consequences for people’s quality of life.”
Zo Schmidt was told their entire life that they had treatment-resistant depression; after they attempted a variety of medications and therapy, a psychiatrist diagnosed them with ADHD and prescribed Adderall in 2019. They now take it a “majority” of their days, and it’s helped them not only focus on work, but on tasks like driving.
“I’m just able to function way better when I have it,” Schmidt, 27, told VICE News. “The first time I took it, I was like, ‘This has to be a placebo effect, because I feel amazing.’”
But when VICE News spoke with Schmidt in March, they hadn’t been able to get their prescription filled in a month. The lack of medication has had a damaging impact beyond the inability to focus.
“The impact on my mental health is something I think I had forgotten or not fully realized, because my depression has been just super bad lately,” Schmidt said. “The weather’s getting nicer, it’s the time of year where I should be feeling pretty good, but instead it’s just harder to remind myself to eat and harder to get out of bed in the morning.”
Ali, a 48-year-old video editor from Chicago, was first diagnosed with ADHD when she was 40, after also experiencing a lifelong battle with depression. Her brain fog symptoms were exacerbated after she gave birth, and her doctor suggested she try a low dosage of Adderall.
“Taking it has definitely had a very positive impact,” Ali said. “Occasionally I take a day off and I don’t feel bad, but I definitely could not do my job, could not focus on a lot of little details.”
Ali, who requested her last name not be published in this story, had heard from friends for months that they’d had trouble filling prescriptions. But she didn’t begin having problems herself until March, when she found out the medication wasn’t in stock at her usual pharmacy.
Ali called several more pharmacies with no luck; one pharmacist said they only had 5 milligram tablets in stock, and that because she takes 10 milligrams, she should talk to her insurance company and doctor to try to get the prescription revised. But by the time she was able to start that process, that pharmacy was out of stock, too.
She finally found a pharmacy that could fill her prescription, but only with the name-brand version, which her insurance doesn’t cover. Usually, she pays a $10 copay for a one-month supply; this time, she paid $268 out-of-pocket. “It sounds dramatic, but I was actually crying in the car, like, ‘I can’t believe I’m going to do this,’” Ali told VICE News.
Ali is trying to get a reimbursement from her insurance company. “If I can’t, I’m not sure what I’m going to do next, because I certainly can’t pay this every month,” she said.
Ford told VICE News that he called more than a dozen pharmacies in D.C. before he found what he needed. Finally he found a pharmacy that carried the name brand. Normally, a one-month supply with his insurance is $20. But because his insurance also only covers generic, and he needed a two-month supply due to an upcoming trip out of the country, he had to pay $460 out of pocket, or $230 per 30-day-supply—more than ten times what he usually pays.
The shortage has also been frustrating for providers. Dr. Sasha Hamdani, a board-certified psychiatrist and author of a book called “Self Care for People With ADHD,” told VICE News that she sometimes logs on as early as 5:30 a.m. and checks her messages on the weekend to help patients attempting to navigate the shortage.
On a recent Monday, she came into work to find 900 messages in her inbox.
“I just started crying, because I was like, ‘I don’t even know how I’m gonna get through this.’ It’s so overwhelming,” Hamdani told VICE News Wednesday. “The people that are going through this are people who have been on this for 12 years. They’re totally legitimate.”
Parents of children diagnosed with ADHD have reported problems as well, Dr. Mike Kane, a child psychiatrist and associate professor at the University of North Carolina School of Medicine, told VICE News last month.
“[Parents] are really frustrated that there’s a mental health access issue that’s always been there. Folks are waiting months at times to be seen, and it just adds another layer,” Kane said.
Kane told VICE News that he has patients whose families are rationing their medication.
“I’ve had at least one family who were like, ‘We’re approaching spring break and we’ve got one pill left, and we’re saving it for that first day back to school and not treating through spring break while we try to track down a pharmacy that has supply of this medicine,’” Kane said.
“We’re approaching spring break and we’ve got one pill left, and we’re saving it for that first day back to school and not treating through spring break while we try to track down a pharmacy that has supply of this medicine.”
Since its approval in 2001, Adderall has been classified as Schedule II Controlled Substance, defined as having a “high potential for abuse which may lead to severe psychological or physical dependence.”
Though the shortage has lasted for months, it’s not the first time this has happened; there was a shortage of Adderall and other ADHD drugs such as Ritalin in 2011. At the time, the FDA blamed the shortage on DEA quotas; the DEA, for its part, blamed manufacturers.
Federal drug policy is likely playing a role in this shortage. In 2021, the government entered into a $20 billion-plus settlement with the three biggest drug wholesalers in America to settle lawsuits filed by over a dozen state attorneys general.
As part of that settlement, secret limits went into effect last July blocking pharmacy orders of drugs such as Adderall and the anti-anxiety medication Xanax if they exceed a certain threshold, Bloomberg reported Tuesday. It’s unclear what the threshold even is, because the wholesalers aren’t able to tell pharmacists the threshold or how close pharmacies are to going over it, according to Bloomberg.
The Biden administration is also taking steps to restrict telehealth, which grew exponentially during the pandemic but has come under scrutiny, as providers were sometimes prescribing medications to patients they’d never met. When the national COVID emergency declaration ends in May, new rules will go into effect prohibiting providers from prescribing Schedule II medications like Adderall, Ritalin, and a number of opioid medications, without first seeing a healthcare provider in person.
The Biden administration says the restrictions are needed to curb misuse or abuse of controlled medications, after the opioid epidemic wreaked havoc throughout the country. But telehealth has also expanded access to healthcare, particularly in rural areas and for older Americans. Telehealth was responsible for less than 1 percent of healthcare prior to the pandemic, but 85 percent of physicians believe it’s increased timeliness of care, according to a 2022 survey by the American Medical Association.
Fox said that the 2021 opioid settlement with the wholesalers has been an additional obstacle. “The intent is good, but an unintended consequence is that pharmacies can’t order extra [supply] if they get extra patients on a controlled substance,” Fox said. “And when patients are trying to call around to [different] pharmacies, not every pharmacy feels comfortable telling people they have something in stock…when the supply is so tenuous.”
Rep. Abigail Spanberger, a Democrat from Virginia, sent a letter to the FDA and the DEA in December pleading with officials to “do everything possible to alleviate this shortage as quickly as possible.”
“Patients who rely on Adderall to function daily deserve a comprehensive federal response to ensure access to their medications,” Spanberger wrote to the agencies. Spanberger told the Washington Post in March that she and fellow Democratic Rep. Eric Swalwell spoke with DEA Administrator Anne Milgram on March 6, and said the call was “very productive.”
Though not many legislators appear to share Spanberger’s sense of urgency on Adderall specifically, there has been a recent interest in tackling drug shortages more generally. Along with Adderall, there have been recent high-profile shortages of the diabetes drug Ozempic, the asthma drug albuterol, and even the antibiotic amoxicillin.
In March, the Senate Committee on Homeland Security and Governmental Affairs’ Democratic majority released a report that found drug shortages had spiked nearly 30 percent between 2021 and 2022, with nearly 300 shortages (including Adderall) in effect at the end of 2022.
Fox testified at a hearing in March that the government should take steps to increase transparency from drug manufacturers on source, quality, and reliability.
“With this particular [Adderall] shortage… the companies say they need [a higher] quota, and the DEA say the companies haven’t used it all,” Fox told VICE News. “Because there’s no public reporting on either side, it’s finger-pointing, and I think additional transparency could really help people understand the true root cause.”
Eight months after the initial reports of the shortage, Hamdani said she still doesn’t understand those causes. “What was the problem here? Was it the Teva factory shutting down, was it COVID and not having adequate workers, was it the increase in diagnoses because of the pandemic?” Hamdani said. “It’s hard to say.”
And for those patients who’ve had to manage the current shortage by essentially winging it, the frustration is mounting.
“Part of the thing with executive dysfunction is that it’s really hard to plan stuff like this and it’s really hard to pick up a phone and call a bunch of pharmacists and try to piece together a solution,” Ford said. “We’re already starting at a disadvantage with this.”
“It’s a funny paradox that the thing we’re supposed to do to get this drug is now even harder for us without it.”
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