By Lisa Fields
Since October, a nationwide shortage of the drug Adderall (amphetamine mixed salts) has made it difficult for many patients with ADHD to fill their prescriptions for this medication, which helps them function more effectively.
Manufacturers of the branded and generic medication are unable to keep up with the increasing demand. The shortages have also been partly related to supply chain issues. Experts predict that the shortage may continue for several more months.
“The national shortage of many stimulant medications indicated to treat ADHD has caused great difficulties for prescribers and medical offices, pharmacies, patients and their families,” says Dr. Birgit Amann, a psychiatrist in Troy, Michigan. “Like most, our office gets phone calls about this shortage from patients and pharmacies each and every day.”
We asked several ADHD experts what patients should do if they’re having difficulty locating Adderall. If you have a prescription to fill, try these ideas:
Your usual pharmacy may be out of Adderall, but other local pharmacies may have a supply on hand. Pharmacists may or may not tell you by phone if they have it in stock, but they should share that information with healthcare providers. Locating enough medication helps providers know where to send a prescription. Prescriptions can’t be transferred between pharmacies because Adderall is a controlled substance.
“I’ve had a number of patients with this same issue, and indeed we have asked them to call local pharmacies and see if they had any Adderall in stock,” says Dr. Alex Dimitriu, a psychiatrist in Menlo Park, California.
Sometimes, a pharmacy may not have your dosage, but it may have enough smaller capsules to give you the correct amount of medication — for example, three 5 mg capsules for a 15 mg prescription. However, some health insurance companies make it difficult to fill prescriptions this way.
“Insurance typically will not approve any extended-release capsule for more than once per day and therefore would need prior authorization,” says Joe Gagnon, Jr., a psychiatric mental health nurse practitioner in Philadelphia. “This adds to more delays and additional time without medication.”
Try Independent Pharmacies
You may be more successful getting your prescription filled at independently owned pharmacies, rather than chain retailers.
“I find far fewer issues with these pharmacies being able to obtain Adderall,” Gagnon says. “One of the best things that I have ever done for my personal practice was to become very close with a locally-owned community pharmacy, and in particular their head pharmacist. I encourage all of my clients to use this pharmacy, and their medications are delivered each month. I reach out to their pharmacist before sending any Adderall (prescriptions), ensure which doses are available and build that into my session.”
Settle for a Different Formulation
Adderall comes in short-acting and extended-release varieties. If your pharmacy has short-acting medication but you take extended-release, your provider may revise your prescription.
“That requires (patients) to take their medications more frequently,” Dr. Amann says.
For example, if you normally take extended-release Adderall in the morning, you may take short-acting Adderall in the morning and afternoon. Your provider will instruct you.
“The timing between doses is essential to maintain the level of medication in the blood and avoid any ‘crash,’ or sharp decreases in concentration — by waiting too long between doses,” Gagnon says.
Some patients whose pharmacies can’t fill Adderall prescriptions choose to skip taking it on certain days so that their limited supply will last longer.
“Some patients ‘save’ their stimulant supply for when it’s really needed — like work or school — and either take less, or pass taking the medicine when not essential,” Dr. Dimitriu says.
But this option works for some patients better than others.
“I have clients who cannot take days off their medication, and if they are forced to do so, it can have a significant impact on their life, (impacting) relationships, jobs, driving, etc.,” Gagnon says. “I have other clients whose ADHD symptoms are more severe in different settings, and they only need the med at certain times — for example, on work or school days.”
Consider Other ADHD Medication
If Adderall isn’t available, your doctor may prescribe another ADHD medication. When possible, doctors should prescribe another amphetamine-based medication. Gagnon says he often prescribes Adzenys-XR ODT (amphetamine) when patients can’t access Adderall.
If your current prescription is for the generic version of Adderall, you might also talk with your insurance carrier to see if it can approve the brand-name medication. The brand-name medication seems not to be as severely impacted by the shortage as the generic medication.
Prescribing methylphenidate (Ritalin) to patients who take Adderall may be inappropriate, experts say.
“The two classes of stimulants are completely different from one another, (and) individuals typically have different genetic responses to each of the two classes,” Gagnon says. “This would be like switching your blood-pressure medicine from one class to another, or a mood stabilizer from one class to another, and we would never do that just because of availability.”
Try Non-stimulant Medications
Several non-stimulant medications are also used to treat ADHD. Non-stimulant medications do not contain methylphenidate or amphetamine. They are less potent than stimulant medications and do not have the potential for abuse; therefore, they are not controlled substances.
The Food and Drug Administration approved a new non-stimulant medication called Qelbree (viloxazine) to treat ADHD in 2021. Dr. Amann prescribes it to some patients when Adderall is unavailable.
In addition to Qelbree, other non-stimulants used to treat ADHD include atomoxetine (brand name Strattera), guanfacine (brand name Intuniv), and clonidine (brand name Kapvay).
“Modifying their treatment to a non-stimulant medication during a time like this can offer substantial relief to all involved,” Dr. Amann says. “These are not in short supply and are not controlled substances. We can offer refills and have samples … making it readily available to our patients.”
Some patients with ADHD may benefit from Wellbutrin (bupropion), an antidepressant.
“Wellbutrin is an atypical antidepressant,” Gagnon says. “Wellbutrin is similar in some ways to the effects, over time, of Adderall.”
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. “Hopefully, there will be improvements in access, supply and resolution soon, so that our patients can continue to have the medicinal support they need to live their daily lives more successfully.”
Online Information on Drug Shortages
You can learn more about medication shortages — including amphetamine mixed salts — this website.