Issues span beyond supply and demand.
In October 2022, the U.S. Food and Drug Administration announced a shortage of amphetamine mixed salts, commonly known by the brand name Adderall, due to an increase in demand. This drug is commonly used to help treat attention deficit hyperactivity disorder, or ADHD.
When elementary school in the United States became standard in the early 1900s, people discovered that a small percentage of children showed trouble adapting. We called this ADHD, “for people who were overdeveloped in the distractibility sense and underdeveloped in the sustained attention sense,” said Dr. Will Cronenwett, a psychiatrist at Northwestern Memorial Hospital.
Years ago, doctors found that stimulants, such as amphetamines, are a great resource to help people manage their symptoms. Data from 2022 states that 45 million Americans have a prescription for Adderall, and that number is only rising.
In the case of such a common and longstanding drug, one may ask: “What is going on?”
According to DeAndria Sutton, a pharmacy technician at Walgreens in Chicago, “Each manufacturer has, like, a quota of how many controlled medications they can produce per specific amount of time.” During the COVID-19 pandemic, Sutton said many people had time to focus on their mental health and got evaluated for things like ADHD. “So, the demand for it went up, but production stayed the same,” said Sutton.
The pandemic, however, was not the beginning of increased demand. In the past five years, Adderall prescriptions have increased by over 30%. In the years from 2006 to 2016, amphetamine use more than doubled, showing a steady heightened demand far before COVID.
“There has been a gradual increase in people who are looking to medical treatment for attention problems over time, and I think that the pandemic has just really exacerbated that,” said Cronenwett.
Lives Altered: The Struggle to Cope
“It has been horrible,” said Sutton about dealing with the shortage. She says she has seen issues with the supply of stimulant medications like Adderall for years.
“Even now, it’s like, I have no idea what other pharmacies have it, and I cannot make a guarantee to you that you can call 10 pharmacies and be able to even find it.”
Because Adderall is a controlled substance, the process of acquiring it is much more rigorous than with other drugs that have a lower risk of abuse. With the shortage, getting the medication can be even harder.
One of Sutton’s patients, a law student, came in one morning to pick up his Adderall before an important exam. The pharmacy staff called the patient’s doctor’s office several times trying to expedite the process of getting an electronic prescription sent over.
The staff checked every moment for the script to come through over the computer, as prescriptions for Adderall cannot be made over the phone. After contacting the school’s dean, the student was granted a short extension to show up, otherwise, he would miss his exam.
“So, this man sat studying in our sitting room, looking at his law books, and waiting three hours for his medication because we had to wait for a prescription from the doctor,” Sutton said. At the time, this Walgreens was one of the only pharmacies in the area that had any Adderall at all.
“I can’t imagine being him, having to take this life-changing exam … and having to, you know, roll the dice, because he’s so dependent on having that for school,” said Sutton.
Sutton says the worst part of the shortage for her is working hard daily to get Adderall for her patients and the order not showing up. Then, she has to deliver disappointing news.
“I’m calling them and … I’m just like, ‘I once again have failed you,’” said Sutton. However, since the shortage has gone on for months, Sutton thinks patients have adjusted to the difficulties of getting their medication.
Sonja Larsen, a Columbia College Chicago student, says the shortage has affected her for five to six months. During her finals last semester, Larsen was not able to get her Adderall. Her pharmacy was out and she was told to return in a few days.
“I went to the pharmacy probably four times before I got my prescription filled,” Larsen said. “I’ve kind of had to ration out my medication because I want to avoid that happening.”
Ila Dovre Wudali, a University of Denver student, has also struggled with getting her ADHD medication. Currently, there is not any Adderall within a 20-mile radius of her mother, who gets it for her. “When I don’t take it, it’s tough. I definitely get pretty fidgety, and I have a lack of motivation, a lot less energy,” said Wudali.
Exploring different pharmacy options may help someone who is having trouble getting their prescription refilled. Sutton suggests places like Mariano’s, Jewel-Osco or Costco. Although not ideal, planning skip days to conserve Adderall through the shortage can extend times between refills.
Shortage-Era Adderall Difficulties
Many people on the internet were reporting — at the same time — that their medicine felt like it stopped working. In Reddit groups like r/ADHD and thousands of people on TikTok, many people were saying the same thing: since the shortage, their stimulants do not feel the same.
There are TikTok videos showing negative tests for amphetamines while the people say they are consistently taking pills that are supposed to contain that drug.
“I’ve had … a really hard time starting my work, which was a huge issue for me before I started being medicated,” Wudali said.
“When it starts to kick in, you can really feel it, and I feel like that has kind of gone away,” Wudali said. Wudali also reports a recent lack of motivation and focus, so much so that she took on fewer classes this term.
This potential efficacy issue may cause more frustration to the shortage for some people. Given how difficult it is to get ahold of any form of amphetamines now, requesting a certain generic or switching doses adds another step to living a functioning life with ADHD.
Sutton and Cronenwett have said that they do not see any evidence to show a change in the efficacy of Adderall.
“The FDA has strict parameters on how much of an active compound needs to be in a pill. And they have strict control over how much a generic version has to resemble the real version,” Cronenwett said.
Sutton said, “It would be very strange if there was any different chemical makeup of the Adderall being currently produced. I just don’t see that.”
Cronenwett suggested for those who feel like their pills aren’t working to see if a supplier or laboratory changed, if they got a different brand, or if it came from overseas.
“I really doubt that there’s some kind of organized conspiracy behind this. I don’t think that the labs have suddenly dropped the active ingredient by 50% and are sending out, you know, cheap pills and not telling anybody about it,” said Cronenwett.
No one seems to have a definitive answer to this concern quite yet.
How Do Stimulants Work?
Cronenwett said that, in simple terms, “neurotransmitters are molecules that neurons in the brain use to talk to one another,” and, “we can say that the stimulants make the neurotransmitters dopamine and norepinephrine more available for neurons to use.”
According to Cronenwett, stimulants like Adderall help ADHD patients finish tasks they would otherwise find hard to complete without distraction.
Amphetamines, at the right dose, bring people between relaxed and obsessive states. “You want to be just obsessive enough to get your tasks done and just relaxed enough so that you’re not a ball of stress all the time,” said Cronenwett.
“All that the Adderall does is make those people [with ADHD] on a normal playing field,” said Sutton.
Diagnosis of ADHD is complicated. Cronenwett said, “There’s no biological marker for ADHD. You can’t dissect somebody’s brain. You can’t measure their dopamine. You can’t put them in a scanner.”
There are some controversies around ADHD diagnoses, especially with the concept of adult ADHD.
Given that ADHD is a developmental disorder, symptoms are often noted in childhood. Cronenwett says plenty of issues like boredom, fatigue, insomnia, and alcohol or cannabis use may lead to adults exhibiting concentration problems. Disorders like anxiety or depression may also affect concentration.
However, it is rare for ADHD specifically to develop in adulthood.“A lot more people in adulthood are curious as to whether they have ADHD than actually do because there are so many different ways that concentration, focus and attention can be impacted,” Cronenwett said.
Endless Distractions, Shorter Attention Spans
Modern media, such as punchy commercials or endless TikTok videos, require less sustained attention. “We keep rewarding this distractibility, and so we train people to expect it and to want it,” said Cronenwett. However, we are “not training people to exercise the parts of their brain that sustain attention and focus,” Cronenwett said.
We have had cultural shifts that have made us more distractible, as well. “We have an entertainment and sensory culture that really caters towards this distractibility in us, and … it makes that our comfort zone,” Cronenwett said. So, slowing down to focus can feel uncomfortable.
“The whole issue is quite complicated, and I don’t really know that we’re ever able to separate it out from culture,” said Cronenwett.
There is “pretty believable research showing that the way that ADHD is diagnosed in practice is a little bit looser than the research criteria upon which the diagnosis is founded,” Cronenwett said.
Sutton said she has noticed a lot of doctors that are generous with writing prescriptions. It is possible to get ADHD medication from immediate care physicians online or in clinics, which became a popular option during the pandemic.
“You see this patient for maybe 20 minutes … I don’t think that qualifies you to, to decide that this patient has ADHD,” said Sutton. Cronenwett said some doctors, “just go by sort of what the patient tells them, and they start writing prescriptions.”
However, Cronenwett believes that these possible overdiagnoses are coming from a place of good faith in the doctors. He believes doctors want to help and have the tools to help someone who seems to be struggling, so they use them.
Depending on who you talk to, medicine may or may not be needed for ADHD. Dr. Cronenwett says that medication for ADHD is not necessary for anyone, but it can be helpful for some.
He does not want to lead people to believe stimulants are the only way to address attention issues. Cronenwett said there are more ways to help people function with the brains they have.
Cronenwett said, “There’s a lot more excitement about taking Adderall, and I don’t know if that means we’re finally fixing the underdiagnosis problem, or if we’re creating more of an overdiagnosis problem.”
Header illustration by Julia Hester