By Lisa Fields
In August, the U.S. Food and Drug Administration (FDA) and the U.S. Drug Enforcement Administration (DEA) released a joint letter providing an update on the nationwide shortage of the ADHD medication Adderall — a shortage the FDA first announced in October 2022. The letter said that the agencies are working with manufacturers and other groups to help improve the shortage.
Nearly a year after the initial FDA announcement, the medication is still in short supply. Many people continue to have difficulty filling prescriptions for Adderall (also known as amphetamine mixed salts), a drug that helps patients manage their ADHD symptoms. Some people spend time tracking down the medication at local pharmacies each month, which is usually an unnecessary step when doctors prescribe medication.
“Patients continue to feel frustrated by not being able to obtain their medications in a timely fashion or at all, month after month,” says Dr. Birgit Amann, a psychiatrist in Troy, Mich. “Pharmacists and pharmacy staff are frustrated, as are medical office staff, prescribers and the patients. This frustration causes tension for all.”
Manufacturing and supply-chain issues initially contributed to the Adderall shortage. Another significant factor was an increase in the total number of patients nationwide being treated for ADHD in recent years. During the pandemic, doctors began prescribing ADHD medication more frequently, leading to “record-high prescription rates of stimulant medications,” including Adderall, according to the joint FDA-DEA letter.
Because Adderall is a controlled substance, the DEA sets annual quotas to limit how much of the drug may be manufactured each year. The jump in total Adderall prescriptions in recent years, combined with the DEA limits, has made it harder for patients to get their medication.
“During COVID and to the present, the Adderall shortage was caused by a reduction in manufacturing and an increase in prescriptions,” says Dr. Alex Dimitriu, a psychiatrist in Menlo Park, Calif. “As the supply improves, we should expect the shortages to improve, as well.”
After conducting an internal analysis of data provided by drug manufacturers, the DEA determined that manufacturers of amphetamine products (including Adderall) only produced about 70% of their allotted annual quota in 2022, with 2023 data looking similar. The FDA and DEA are now encouraging manufacturers to increase production to meet their quota allotment or to relinquish their quota allotment so that other manufacturers may meet the need.
“If the FDA and DEA are encouraging manufacturers to increase their production, it would appear that they are understanding the significantly negative impact this has had on our ADHD patients,” Amann says.
While the shortage continues, we wanted to offer some advice from experts on how people with ADHD can deal with the shortage.
Here are some tips:
• Get To Know Your Pharmacist
Remember you are in the driver’s seat when it comes to your health care. By forming a trusted relationship with your pharmacist and their teams, you and your pharmacist are better able to advocate for your best care.
Talk with your pharmacist about the medication shortages and what to expect each time you need to refill your prescription. That will help you both have clear expectations about how to minimize the impact of the shortage.
Many pharmacists will let you know how soon they will be able to fill your medication, or recommend an alternative dose, strength or medication that might work for you.
Remember, a pharmacist can’t change your prescription; if you need to alter your prescription, you have to request that change from your provider.
Also remember this: If your pharmacist can only partially fill a prescription, they can’t give you the “rest of that one” when the stock is replenished. That will require the provider to send in a new prescription with new dates and quantities.
Your pharmacist is a licensed healthcare professional and has a responsibility to help keep patients safe.
• Talk To Your Health Care Provider About a Back-up Plan
During your next visit, talk with your health care provider about a back-up plan for medication shortage problems. You can discuss any options and make a plan together. Your provider must share the risks and benefits of any new medication with you, so go ahead and start those conversations in case that happens. You can also discuss things like a medication holiday (suspending taking the medication for a short time), or an alternative dose or schedule for taking medication.
Your provider is a key member of your care team. By having these conversations ahead of time, you can feel more confident about advocating for any changes you need if and when you need them.
• Request Refills In Advance
By getting to know your pharmacy team and talking with your provider about a back-up plan, you are prepared for solving shortage problems.
Your pharmacist can tell you how soon they will have regular stock or be able to fill your prescription. If it is longer than one week, you may need to request a transfer of your prescription to a new pharmacy. But that should be a last resort. Staying with the same pharmacy improves continuity of care and the overall quality of your care.
If you know your pharmacy is struggling to keep stock in place, contact your provider to request the refill submission early, which helps the pharmacy know ahead of time how much medication they need in the near future.
You will still be picking up the medication when it is due to be picked up. But you have given your provider and pharmacist advance notice so they can work to get your medication filled on the day it is due.
• Call Your Health Plan (if you have one)
If you are experiencing challenges with the medication shortage and have a back-up plan forming with your provider, or if you want to know which medications are covered by your insurance, give them a call and ask.
Be sure to let them know you are having difficulty getting your medication filled and ask about alternatives you have discussed with your provider and what your out-of-pocket costs would be. Also ask about any other requirements to have those medications covered.
Your health plan may also be able to offer recommendations for preferred pharmacies or mail order options, so be sure to ask about those as well.
• See an ADHD Coach
Meeting with an executive-functioning coach may also help you manage your ADHD symptoms more effectively.
“The skills they learn from ADHD coaching and counseling are particularly important to utilize if they are on less, or none, of their medications because of a national shortage,” Dr. Amann says.
• Stay Current On the Shortage Status
Continually monitor the Patient Updates page on the ADHD Online website. ADHD Online works hard to be a reliable reliable resource for people with ADHD who are struggling to better understand treatment pathways and plans, the impact of things like the medication shortage and telemedicine for controlled substances, as well as ADHD management tools and resources.
Also check out ADHD Online’s Prescriptions page, where you can find information on the different types of medications used to treat ADHD. If your back-up plan includes alternative medications, take a few minutes and review the information about those medications.
You can also monitor and learn more about medication shortages — including the Adderall shortage — at this website.