Three pills short. That’s what I found I’d be as I packed my bags for a summer program at the School of The New York Times. I didn’t have enough dexmethylphenidate (a stimulant that helps treat ADHD) doses for the whole course, and I knew I’d need to focus. So then, on which days would I be able to pay attention easily, and on which days would I have to put in double the effort?
It’s a decision that many Americans living with Attention Deficit Hyperactivity Disorder (ADHD) have had to make this past year. In autumn of 2022, an Adderall shortage was announced by the FDA. There’s no singular cause for the shortage, but a combination of manufacturing delays and a growing demand for ADHD medication as a result of the pandemic and telehealth -- online therapy which has made prescriptions significantly easier to obtain -- are mostly to blame.
Adderall was the first of the ADHD medications to be in short supply. Many users were then prescribed other ADHD medications like Focalin, the maker of dexmethylphenidate, which I take. But this was only a temporary solution. In recent months, these drugs, including Focalin, Ritalin, and Vyvanse, three common Adderall alternatives, have also appeared on the list of shortages.
We’re over a month into the school year, and the shortages have not let up. It poses a real problem for students with ADHD, who rely on medications like Adderall to keep up with their classmates. We need federal agencies and big pharma to stop pointing fingers at each other and start working together to find solutions.
While blame can partly fall on manufacturing delays, the shortage has lasted as long as it has largely due to an increase in demand. During the pandemic, telehealth saw a huge boom, which was great because people could still receive mental healthcare in lockdown during an incredibly stressful time. The downside of this shift is that people were suddenly able to receive prescriptions for controlled substances like Adderall without a previously required in-person diagnosis. Telehealth companies capitalized on the lack of regulations, and according to data analyzed by the Washington Post, Adderall prescriptions rose by over 30% in the past five years, and accelerated even more during the pandemic.
Another problem is that misinformation regarding mental health is rampant on social media, leading people to incorrectly diagnose themselves with ADHD. A study from the Canadian Journal of Psychiatry assessed the 100 most popular Tik Toks under the “ADHD” hashtag (which has racked up over 27 billion views on the site). It classified 52% as misleading, 27% as a “personal” assessment and just 21% as “useful,” meaning it contained scientifically accurate information on ADHD.
Even worse, some companies have used Tik Tok to actively spread misinformation about ADHD. Done Health, a telemedicine company with an “F” rating from the Better Business Bureau, has been overgeneralizing ADHD symptoms in their advertisements for over a year to attract more customers. The company is also under investigation by the Drug Enforcement Administration (DEA) for allegedly overprescribing ADHD medication by taking advantage of relaxed regulations from the pandemic.
Speaking of the DEA, it proposed a permanent set of regulations for telehealth in March. These would prevent patients from obtaining a prescription for medications like Adderall over telehealth without an in-person diagnosis. The proposal, which received over 35,000 comments, seemed like exactly what we needed.
But in May, the DEA extended telemedicine’s COVID-era flexibilities for another six months while they claimed they would “work to find a way forward…with appropriate safeguards,” administrator Anne Milgram said in a media statement. The extension is set to last into November, and by that time students will be approaching the second quarter of the school year. Time is running out.
Telehealth is not the only exacerbator of this problem. Producing drugs is a complex process, and it’s not as simple as “just making more.” For controlled substances like Adderall, there are legal quotas that limit how much can be made so as to prevent a surplus, which could lead to much easier access and abuse. And Big Pharma notoriously lacks transparency, making it difficult to predict the end of these shortages.
In the meantime, we have to adapt. Adults who received a telehealth diagnosis should question if they truly need medication. Additionally, they may want to consult with a doctor in person to confirm their diagnosis and discuss other possible treatment plans.
Of course, everyone should have the option of medication if they have ADHD. Giving it up is a big ask, especially for long-term users.
But it’s a different story for those who aren’t diagnosed or who received it in a wave of telehealth over-prescriptions. A Trilliant Health analysis of insurance claims found that for adults 22 to 44 years old, Adderall prescriptions increased 58% between 2018 and 2022. Even more startling, there were more adults with an Adderall prescription than those with an ADHD diagnosis.
For now, there are other forms of ADHD management that patients can consider, ones that don’t require medication. These are most effective for people with less severe symptoms. Although results vary, non-drug treatments for ADHD are often worth a shot. Plus, non-medicinal strategies learned in just a few sessions can be applied without constant expenses for refills.
I made it through my course at the School of The New York Times. Thankfully, my instructor said that she hadn’t noticed a lack of focus from me. Even so, I still felt anxious rationing my pills. And what about when my current prescription runs out during the school year? I pulled through this time, but what about the next?