The Washington PostDemocracy Dies in Darkness

Adderall shortage is so bad some patients can’t fill their prescriptions

(JB Reed/Bloomberg News)

A national shortage of Adderall has left patients who rely on the pills for attention-deficit/hyperactivity disorder scrambling to find alternative treatments and uncertain whether they will be able to refill their medication.

The Food and Drug Administration announced the shortage last week, saying that one of the largest producers is experiencing “intermittent manufacturing delays” and that other makers cannot keep up with demand.

Some patients say the announcement was a belated acknowledgment of a reality they have faced for months — pharmacies unable to fill their orders and anxiety about whether they will run out of a medication needed to manage their daily lives.

Experts say it is often difficult for patients to access Adderall, a stimulant that is tightly regulated as a controlled substance because of high potential for abuse. Medication management generally requires monthly doctor visits. There have been other shortages in recent years.

“This one is more sustained,” said Timothy Wilens, an ADHD expert and chief of child and adolescent psychiatry at Massachusetts General Hospital who said access issues stretch back to spring. “It’s putting pressure on patients, and it’s putting pressure on institutions that support the patients.”

Erik Gude, a 28-year-old chef who lives in Atlanta, experiences regular challenges filling his Adderall prescription, whether it’s pharmacies not carrying generic versions or disputes with insurers. He has been off the medication for a month after his local pharmacy ran out.

ADHD doctors weigh in on whether to take meds while pregnant

“People with ADHD generally have lower frustration tolerances, but there’s a very particular type of frustration when you’ve done all the things you’re supposed to do, you’ve made all the phone calls, you’ve made all the appointments, you do all the things that are extremely hard to do with ADHD,” said Gude, who chronicles living with the condition on TikTok, YouTube and Twitch as @HeyGude, as well as on a podcast.

Since he has been off his medication, Gude said, his brain has felt fuzzier and he has had more difficulty cooking, caring for his dog and maintaining normal sleep patterns. He found himself sidetracked and playing the piano for an hour and a half. His mother texted him when she grew concerned that he had stopped regularly posting in a family group chat.

Gude is hesitant to return to his doctor to ask for alternative medication after spending five years figuring out how to best manage his treatment and side effects.

“You are weighing the deficits of not being medicated at all with the devil you don’t know,” Gude said.

Doctors say patients who have trouble obtaining Adderall have other options because the shortage is uneven — with some tablet formulations and doses more plentiful than others.

Max Wiznitzer, an Ohio neurologist who treats children and young adults who have ADHD, said some patients who take immediate-release tablets, which is what the FDA declared in short supply, could temporarily switch to an extended-release formulation or other brands. But any changes should be made under the guidance of a doctor after an evaluation of the patient’s medical history, he said.

Doctors share advice on dealing with the Adderall shortage

“This is just another speed bump in medicine management,” said Wiznitzer, who is also a board member with the advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder. “There are a variety of solutions.”

Some patients say the options are not solving their problem.

Becky Litvintchouk, a 38-year-old who has taken Adderall on and off since she was a teenager, says she was forced to switch to immediate-release tablets that left her with headaches and a racing heartbeat after she was unable to find a pharmacy on Long Island stocked with the extended-release tablets she usually takes. She is wary of alternatives to Adderall after previous medication changes led to severe depression.

Experts and patient advocates say people with ADHD can struggle to navigate the medical bureaucracy to access alternative treatments that work. Symptoms of ADHD include trouble organizing and focusing on tasks, particularly when they take a long time.

“It’s like a Catch-22 that you need to find motivation to get your motivation pills,” said Holly Freeburg, a 34-year-old in central Illinois whose local Walgreens ran out of Adderall in April.

She had to skip her medication for several days and missed work at a housekeeping job because of challenges remembering details and handling stress. Freeburg said she was fortunate to have friends who work in medicine and parents who helped her make calls to find a pharmacy in a nearby town that had the drug in stock.

Erin Fox, who monitors drug shortages as a senior pharmacy director at University of Utah Health, said there have been repeated shortages of different types of Adderall since 2015. Limits on how Adderall can be supplied and transferred make it more challenging to distribute during shortages.

“We have pharmacies, larger chains and large distributors that have been under increased scrutiny for how they manage controlled substances,” Fox said. “It’s not like a pharmacy can double the amount of their order if they suddenly get a lot of patients.”

This is why it's so hard to find a therapist right now

Experts say the rise of telehealth psychiatric services has made it easier for patients to access Adderall and other amphetamines used to treat ADHD. The online mental health start-up Cerebral paused Adderall prescriptions in May as the company faced allegations of overprescribing and an investigation by the Justice Department.

Fox said that without more data on prescriptions, blaming telehealth for the shortage would be speculation.

Teva Pharmaceutical is reporting the most widespread shortages of Adderall, a situation that is expected to ease in coming months, according to an FDA database.

A Teva spokesperson said the company has been producing branded and generic Adderall “at levels above historical demand.”

“It is possible that some people may encounter a back-order (intermittently) based on timing and demand, but these are only temporary,” Kelley Dougherty, the spokesperson, wrote in an email. “We are fully committed to uninterrupted supply and continuing to manufacture and distribute as much product as possible each day. We are working closely with our manufacturing facility and the [Drug Enforcement Administration] to see what additional volume we may be able to support in the future.”

Adderall presents esports with an enigma

Dougherty had previously attributed the most recent delays to a labor shortage that has since been resolved.

The Adderall shortage has become a national punchline on “Saturday Night Live” and “The Daily Show” over the past week, and people on social media are joking that college grades are about to plunge.

The response has frustrated people with ADHD who say their conditions have long been dismissed and their use of stimulants treated with suspicion.

“Adderall is not just there to help you write your college term paper. It’s there so you can feed your kids and go to work and run a household and manage your life,” said Cate Osborn, a 34-year-old Atlanta resident who co-hosts the ADHD podcast “Catie and Erik’s Infinite Quest” with Gude. “For a lot of people, this is vital, lifesaving medication. It is the difference between thriving and surviving.”

Litvintchouk, the New Yorker who had to switch to immediate-release tablets, said the Adderall shortage should be viewed like a shortage of insulin for diabetics and other treatments for chronic conditions.

“The jokes are like, ‘Oh well, guess the finance bros will have to start taking cocaine,’” Litvintchouk said. “We are not taking it for performance. We are taking it just to be normal, to do our jobs and to be able to function in society.”

Litvintchouk was able to get back on her preferred extended-release medication with her latest refill last week. But after several months of calling multiple pharmacies and no immediate end in sight to the shortage, she is not sure what next month’s refill will bring.

She is considering stockpiling her medicine by skipping pills on weekends, when she doesn’t have to go to her marketing job and can better tolerate being miserable and anxious.