Decoding the ADHD Crisis and the Adderall Shortage

 Megha Jain 

Prof. Horgan 

HST 401- A


12/8/2023

Decoding the ADHD Crisis and the Adderall Shortage 


Maya is a proud homebody. Trying to convince her to go to Starbucks, the movies, the mall, or any other hangout spot is a huge challenge. So, what changes when she frantically calls me on a random Tuesday four months ago and tells me to drive her three hours away to a remote pharmacy in Binghamton? She is undoubtedly very particular about her car and does not let others drive it easily. What could be so important for her that she is willingly leaving the comfort of her house and making me drive three hours with her? 

The answer, as it turns out, lies in the urgency of obtaining Adderall, a popular medication prescribed for people diagnosed with attention deficit hyperactivity disorder (ADHD). ADHD is a brain disorder that impacts one's ability to focus, increases impulsivity and sometimes leads to hyperactivity. Contrary to popular belief, ADHD is not a mental illness; it is not a specific learning disability; it is a developmental impairment of the brain's self-management system (ADDitude Editors). The existence of ADHD is frequently subject to controversies; however, it is acknowledged as a real medical disorder by many known institutions, such as the National Institute of Health and the U.S. Department of Education. Then the question arises: how are so many people being diagnosed with ADHD if it is a real medical disorder? Well, the answer is complicated because various factors go into it. 

Maya's anxious and fidgety behavior on our drive to the remote pharmacy unveiled a side of her that I never really fully understood. On our car ride, I got the opportunity to learn more about ADHD and the Adderall crisis, and it got me thinking that this crisis is more than Maya's story; it is a snapshot of a larger problem affecting millions with ADHD. To understand the depth of this issue, let us delve deeper into it.

In the United States, approximately 6 million children and an estimated 8.7 million adults have been diagnosed with ADHD. The Centers for Disease Control and Prevention reports the prevalence of ADHD diagnoses in children and adolescents rose from 6.1 percent in 1997 to 10.2 percent in 2016, marking about a 67 percent increase (Ferguson, S). This revelation sheds light on the soaring diagnosis rates over the past decades and raises questions about its reasons. 

It is important to note that there is no one particular cause for ADHD, but research has shown that genetics and brain injury play a significant role. Notably, there is no simple blood test or brain scan that detects ADHD; a proper diagnosis requires various types of tests. Unfortunately, in haste, parents or adults can fill out forms too quickly or provide incomplete information, sometimes leading to a “false positive” diagnosis (Ferguson, S). These false positives unknowingly contribute to the rise of ADHD diagnosis. Moreover, according to the New York Times, the explosion in diagnosis rates is connected to sociological factors, especially those related to education and changing child expectations (Baker). American childhood has drastically changed, with more homework, less free time, and more pressure to perform in a competitive environment. This competitive environment leads to increased scrutiny and expectations, prompting parents and teachers to seek explanations for behaviors that may differ from perceived norms. As a result, children who exhibit typical symptoms of ADHD are more likely to undergo diagnostic tests. 

Known as one of the most effective medications for ADHD, the demand for Adderall is always high. In 2021, a staggering 41.4 million Adderall prescriptions were dispensed in the U.S., up more than 10% from 2020, according to IQVIA, a health research firm (Kee). Unfortunately, on October 12, 2022, the FDA declared a shortage of ingredients used to manufacture Adderall, sending shockwaves of chaos and anxiety to those directly affected. A September 2023 survey from the National Community Pharmacists Association found that 94 percent of independent community pharmacies reported experiencing shortages of Adderall or generics (Choi). This shortage not only impacts individuals like Maya but also places a strain on local pharmacies, making it an issue of significant concern. 

(The graph above shows the frequency of shortage as the demand for Adderall has increased over the past 12 years)

The main reason for the shortage of Adderall remains unclear. As with any drug shortage, causes can vary from manufacturing issues to a surge in medication demand. This unprecedented shortage is due to the demand driven by increased prescriptions. Data show that, from 2012 to 2021, there was a 45% increase in the dispensing of stimulants, per the FDA (Kee). Furthermore, the COVID-19 pandemic contributed to the increase in prescriptions, with patients turning to telehealth to get ADHD medication, according to PBS News Hour (Serino). One of the reasons behind this was to address the apparent health disparities at that moment. Online therapy start-ups have also reported thier ability to diagnose ADHD and prescribe drugs easily and quickly (Blum). The CDC reported that the percentage of women and men who received prescriptions increased by more than 10 percent from 2020 to 2021. So, when the demand for any object is high, the changes in supply meeting the demand can be challenging. 

Why is the demand high? According to Dr. Margaret Sibley, a clinical psychologist and researcher specializing in ADHD, unlike some other mental health issues, ADHD has social benefits that are very easily recognized. "People can take an ADHD diagnosis to a school or a workplace and have reduced responsibilities because of it, or accommodation for testing, et cetera." (Korducki) Secondly, people who are prescribed stimulants may use them to treat a condition other than ADHD. Adderall, for example, is also used to treat narcolepsy.

The federal government's role in regulating plays the other reason for the shortage. One of the active ingredients in Adderall is an amphetamine, a highly addictive substance. Therefore, the drug is regulated as a controlled substance under federal law by the FDA and DEA. To avoid having more circulation of the drug than necessary, the DEA caps the amount of amphetamine available to manufacturers in a given year (DuCharme). As a result of this cap, authorized manufacturers apply to receive a portion of the total drug supply and can request more if required. Still, the DEA can deny if the pharmaceutical companies have already met the total quota, among other reasons (DuCharme). This brings us to a place of misunderstanding. According to the Times, pharmaceutical companies are still waiting for the DEA to review its quota application (DuCharme). In contrast, the DEA argues that U.S. companies have not used the total allocated supply in 2020, 2021, or 2022. As a result, the DEA has still not increased the quota for 2023. Furthermore, The FDA and Drug Enforcement Agencies released a letter saying that “manufacturers only sold 70 percent of their allotted quota, with about one billion more doses that they could have been produced, but were not made or shipped” (KCAL News Staff). Neither pharmacies nor the DEA are required to share all the information with the public. This misunderstanding between the pharmacies and the government is hard to solve as there is a lot of back and forth and no real transparency. The pharmacies have financial incentives to sell the medications, and the government has other incentives that they want to use.  



The question arises: Why can't the manufacturer just produce more? The answer is more complex than one may think. Typically, different manufacturers are involved in processing a drug's active ingredients and finalizing its production. Many pharmaceutical manufacturing plants operate at near-peak capacity and make multiple drugs simultaneously. According to Times Magazine, scaling up the production of one drug could require ceasing or reducing the production of another drug, leading to a domino effect (DuCharme).  As a result of the domino effect, long- and short-acting forms of other stimulants used to treat ADHD are in limited supply, too.

The shortage of Adderall is creating withdrawal symptoms that are resulting in chaos and disturbance in people's lives. After the initial withdrawal period subsidies, people still have to confront what comes next, as they face an unknown stretch of time without Adderall and its substitutes (Blum). Lisa, whose daughter is an Adderall user, states, "The shortage is creating huge anxiety in my daughter, which leads to migraines. She does not function as well on other medications." Additionally, research indicates that the shortage is taking a toll on students, with declining grades and loss of motivation. A pediatric psychologist, Parker Houston, told The Hill, "Students' grades are suffering; they're falling behind academically and losing some motivation." 

Reflecting on her experience with the shortage, Maya reveals the challenges she faces. "I am constantly nervous that I won't be able to get my medicine on time. This shortage has not only affected my college work but also impacted my relationships with loved ones. I can no longer keep up with conversations without feeling like I'm not myself. It is honestly a mess. I have been taking Adderall since middle school, and now it's been very hard for me to get used to exploring other alternatives. None of them really help me. I have bad headaches and get flustered easily." Similarly, the struggles are extended to personal hobbies, as evidenced by one of my fencing teammates. “My fencing has drastically changed. I am unable to perform as I like to. It is a daily struggle to show up to practice because I never know what my body will do or not do." There are only a few narratives of people struggling with the shortage of Adderall. Millions of people are unable to express their feelings as they are just trying to cope with their circumstances.

Addressing the shortage requires individuals to take proactive measures. Patients can check thier local pharmacies for prescription availability. People are likely to be successful in obtaining their prescriptions in local pharmacies compared to chain stores. They can also try to manage the side effects of new alternative medications with diets and supplements. In the Attitude magazine, Isa mentions, "I started drinking Matcha. It helps me a lot, and I feel less stressed." Lastly, one should educate oneself about other alternatives that can tackle ADHD, such as counseling, therapy, exercise, diet, and good sleep habits.

Regarding the misunderstanding between the government and pharmacies, the best solution is to spread the word. Many people are unaware of the misunderstanding; if the word is spread, both parties can come together and find a solution. Three months after our car ride, Maya continues to face the challenges but has found some relief with therapy. 

In conclusion, the Adderall shortage crisis is a multifaceted issue that has direct consequences for individuals diagnosed with ADHD. The complex factors, from increased demands and manufacturing challenges to government regulations, have contributed to the ongoing shortage of Adderall. As we navigate these tough times, exploring alternative solutions and advocating for a more transparent approach between healthcare providers and government is important. 


Citations 


  1. ADDitude Editors. (n.d.). What Is ADHD? Symptoms, Causes, Treatments. ADDitude Magazine.https://www.additudemag.com/what-is-adhd-symptoms-causes-treatments/  

  2. Baker, Maggie. (2013, October 20). The Not-So-Hidden Cause Behind the ADHD Epidemic. The New York Times. https://www.nytimes.com/2013/10/20/magazine/the-not-so-hidden-cause-behind-the-adhd-epidemic.html  

  3. Blum, Dani. "The Adderall Shortage and Withdrawal Symptoms for ADHD." The New York Times, November 16, 2022. https://www.nytimes.com/2022/11/16/well/mind/adderall-shortage-withdrawal-symptoms-adhd.html  

  4. Centers for Disease Control and Prevention. (n.d.). ADHD: Data and Statistics. https://www.cdc.gov/ncbddd/adhd/timeline.html   

  5. Choi, Joseph. "House Democrats Demand Answers on Year-Long Adderall Shortage." The Hill, January 9, 2019. https://thehill.com/homenews/4251004-house-democrats-demand-answers-on-year-long-adderall-shortage/  

  6. DuCharme, Jamie. "Adderall Shortage: What to Know." Time, April 18, 2023. https://time.com/6272668/adderall-shortage-update/  

  7. Ferguson, S. (2023, August 15). Why Are ADHD Diagnosis Rates in Children Increasing? Self. https://www.self.com/story/adhd-diagnosis-rates-children-increase  

  8. Kee, C. (2023, October 19). Adderall Shortage: What to Know. Today. https://www.today.com/health/adderall-shortage-rcna119741  

  9. KCAL-News Staff. "ADHD Medication Shortage Continues, Causing Students to Struggle." CBS News, September 28, 2023. https://www.cbsnews.com/losangeles/news/adhd-medication-shortage-continues-causing-students-to-struggle/  

  10. Korducki, Kelli María. "TikTok Trends or the Pandemic: What's Behind the Rise in ADHD Diagnoses." The Guardian, June 2, 2022. https://www.theguardian.com/society/2022/jun/02/tiktok-trends-or-the-pandemic-whats-behind-the-rise-in-adhd-diagnoses  

  11. NHA Health. (n.d.). ADHD Is Not Fake. https://nhahealth.com/adhd-is-not-fake/  

  12. Scott, Dylan. (2023, April 10). The Adderall Shortage of 2023. Vox. https://www.vox.com/policy/2023/4/10/23671128/adhd-medication-adderall-shortage-2023  

  13. Serino, Kenichi. "A Perfect Storm Led to an ADHD Medication Shortage. Here's Why." PBS NewsHour, July 18, 2023. https://www.pbs.org/newshour/health/a-perfect-storm-led-to-an-adhd-medication-shortage-heres-why

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