ADDitude for Professionals

How the Adderall Shortage Is Casting a Long Shadow on ADHD Treatment

In a recent ADDitude survey, ADHD clinicians and other professionals reported that nearly all of their patients currently prescribed Adderall are experiencing treatment disruptions, anxiety around finding medication, and symptom flare-ups with serious professional and mental-health ramifications.

November 23, 2022

The Adderall shortage first reported this summer and confirmed by the U.S. Food and Drug Administration (FDA) in October is dragging on — and dragging down many patients’ mental health in the process. A significant population of patients cannot reliably procure the ADHD medication from local pharmacies, and many prescribers are trying to find alternatives to the immediate and extended-release formulations of Adderall for their patients, according to a recent ADDitude survey. All of this is causing anxiety, treatment disruption, and symptom flare-ups.

In September, 80% of ADDitude poll respondents said they were having trouble getting their ADHD medication. Earlier this month, we asked clinicians, counselors, and other ADHD professionals to assess the percentage of their patients impacted by the Adderall shortage. Their estimates ranged from 1% to 75%. For patients prescribed Adderall, however, there was near universal agreement that new hurdles and headaches exist today.

Severity and Prevalence of the Adderall Shortage

90% of my clients who are treated for ADHD with Adderall are having issues filling their extended-release prescriptions,” wrote one psychiatric-mental health nurse practitioner. “In our area, short-acting Adderall is more easily available. Today, I sent in an Adderall prescription for a client who had to call seven different pharmacies to find one that could fill her generic Adderall XL 30 mg. She was lucky to find it at all.”

“They are entirely unable to access supplies,” wrote a prescribing physician in private practice. “I have attempted to move some patients over to Zenzedi, but it is not without great opposition ranging from a pharmacy’s refusal to stock Zenzedi, the inability to identify pharmacies that stock it, or insurance’s denial of Zenzedi.”

“My patients have told me they are blocked from fulfilling their prescriptions,” wrote one licensed social worker specializing in ADHD. “Doctors I have consulted told me that it is not just the shortage that is the barrier, but it is also becoming more difficult to access Adderall due to restrictions on its use. They tell me that they are resorting to prescribing Wellbutrin or other alternatives. This is additionally challenging because ADHD medications are designed in a way that fits the disorder. Adderall often works instantly and does not require perfect daily adherence to be effective.”

[Download: The Ultimate Guide to ADHD Medication]

“The current Adderall shortage and restrictions negatively impact 75% of my patients,” wrote a licensed social worker specializing in ADHD. I have a homeless adult client with ADHD who is also depressed and anxious. He experienced a barrier to getting Adderall, which demotivated him even further, and he missed his therapy appointment.”

Even when patients do successfully access Adderall with some persistence and good luck, they often do so after missing some number of doses. Many are tempted to skip doses or otherwise alter their treatment plans in order to build a stockpile “just in case.”

“Most of the time, my clients can get their prescription moved to a different pharmacy with Adderall in stock, but that is certainly a hassle and not ideal for clients or doctors,” wrote a licensed professional counselor. “Many patients skip doses or are forced to go without medication for a few days before it is available.”

All of my clients have been able to get Adderall, though some have had to call multiple pharmacies to find their dose,” said another survey respondent. “Others have asked for different strengths if the dose they take is unavailable.”

[Download: A Parent’s Guide to ADHD Medications ]

The Risk of Self-Medicating for ADHD

“Adderall withdrawal” is not a medically verified phenomenon, however it stands to reason that a patient who has effectively managed their symptoms of ADHD using Adderall will face consequences — detriments to attention, focus, executive function, and emotional lability — when that treatment is disrupted. Many ADHD clinicians are reporting exactly this as their patients navigate uncertain waters, and they are concerned about long-term consequences.

“Patients are struggling with consistency of symptom management,” wrote one ADHD professional. “Going days without medication increases their symptoms of rejection sensitive dysphoria.”

“They have missed doses, they have work impairment, and they are trying alternative formulations with varying success,” wrote another.

“What worries me most about the Adderall shortage and barriers to care is that we end up having children and adults who struggle more in productive areas of society like work and school,” wrote one licensed social worker. “We also have more impulsive people making decisions that can lead to problems. My clients often report fearing or getting disciplinary actions at work when their ADHD is left untreated. I also worry about Adderall being sold on the illegal market. Unauthorized sellers would be siphoning an already compromised supply of psychiatric medication with a good track record for treating ADD. The 2022 Adderall shortage and restrictions do not just impact access to Adderall. It can have a negative impact on patients’ trust in professional medication and therapy in general.”

“I worry that patients will turn to buy from illegal sources and that the media attention on the shortage will create a bigger market for this to occur,” wrote one professional.

“I worry about patients trying illegal substances, increasing caffeine (energy drinks), and worsening comorbidities,” wrote a doctor.

Patient Reports Confirm Adderall Worries

From missing dosing to switching medications, ADDitude readers continue to adapt their ADHD treatment amid the Adderall shortage. In a recent poll, patients shared the following stories about medication side effects, treatment-related anxiety and rejection sensitive dysphoria, and unsanctioned changes to their ADHD medication regime.

“I have to settle for medicine from whatever manufacturer the pharmacy can get it from,” wrote one reader in Maryland. “There are some instances where the version of the medication I get makes me feel so awful that I throw it all away, and then I am left with nothing until the next month — just hoping that they’ll be able to fill my prescription with a generic that works well enough.”

“It’s stressful every day, not knowing. And it affects my mental health as well as my job performance and ability to handle my daily life. I am a mess,” she continued. “I have severe ADHD. Adderall helps with my mood disorder as well. But many places don’t recognize it as something serious to deal with. It used to be that I just needed to make sure pharmacists could get it from Teva. Now you get whatever you can get if you can even get anything.”

“I’ve reduced my dosage on weekends, which has not gone well,” wrote a reader in Colorado. “I am sleeping way more and not getting things done like cleaning, recreation, or visiting with friends, which are all self-care for me. I have had to call different pharmacies to see if the immediate-release tablets are in stock. Last month, I called all the national chains and finally found it at a very small pharmacy on the outskirts of town. I am concerned they will not have it when I call back in a week to fill my next prescription. I am already experiencing anxiety about that. The worst part is feeling like I am bothering the pharmacy or feeling like I am calling all the drug dealers in town to find drugs. I have been diagnosed with rejection sensitive disorder, so every pharmacy employee who tells me they are out of Adderall really hurts… My mental health is at stake here.”

“We started rationing medications for our two sons by only giving them medicine five days a week instead of seven,” wrote a parent in Wisconsin. “Because of the need to ration, we skip Sunday School and weekend sports, as our children’s behavior without medication is too much for coaches to handle. I hope this doesn’t persist, or it will start to impact their success at school as well.”

“I had to drop my generic immediate-release Adderall regimen altogether,” wrote a 51-year-old woman with inattentive ADHD in New Mexico. “I have switched to immediate-release methylphenidate, which is somewhat ‘good enough.’ But I absolutely want to go back to my generic Adderall made by Teva when this ‘shortage’ resolves. I cannot tolerate any other manufacturer’s formulation besides Teva’s — my anxiety goes through the roof on the others.”

Adderall Shortage: What Now?

Some ADHD clinicians advise their patients to find local mom-and-pop pharmacies with whom they can build relationships and also to call in refills at least a week in advance. Others recommend exercising daily, eating a nutritious diet, and trying executive function coaching to work through gaps in treatment with Adderall. Many recommend speaking with a doctor about similar alternatives like Adzenys, Mydayis, or other variations of similar compounds.

“I would like to see ADHD clients join support groups. There needs to be more access to behavioral modification resources and affordable coaching,” wrote a psychiatric mental health nurse practitioner. “Care providers need to refer clients to counselors who can help them with behavioral changes, and health insurance companies need to be willing to pay for these services.”

“Right now, we have five options,” she continued. “1. Mix and match the strength of the Adderall to fit the amount needed (e.g., three 10 mg extended-release tabs at one time to equal the 30 mg they would usually take in one capsule). 2. Change to a short-acting dose two to three times a day instead of using extended-release tablets. 3. Try a different medication like Vyvanse or Focalin and hope that insurance will cover it. 4. Try a non-stimulant medication like Strattera or Wellbutrin. 5. Go without any medication and attempt to live again in the fog and chaos brought on by their ADHD, which can mean struggling at school, at work, and in relationships.”

“The price of other medications may be prohibitive for patients who need to be treated,” she continued. “I worry about more accidents from distracted driving, parents not being able to take care of their children effectively, kids developing negative self-concepts because they are struggling in school and getting into trouble, college students being overwhelmed by the demands of college life and class work, and the nurse or doctor who make a mistake because they are having a hard time focusing and making decisions. I am also concerned about the amount of unsafe self-medicating this can lead to and more use of street stimulants to increase energy and focus, as well as benzos, THC, and alcohol to calm hyperactivity, which will lead to more addiction.”

Adderall Shortage: The Big Picture

“This is going to become a long-term problem,” wrote another prescriber. “People who don’t need the meds continue to seek them out, not knowing the repercussions this is causing people that need them. It was already hard enough filling the medication. There’s so much shame at the pharmacy; even I get anxious filling my Adderall as a professional. Now that there is a shortage, there is an added fear of calling and not knowing how the pharmacy will react to me.”

“What worries me most is the apathy of the entire profession of psychiatry and pharmacy to view the legitimacy of ADD treatment in adults,” wrote a prescribing clinician in private practice. “The apathy of the FDA, the apathy of insurance, and helplessness/hopelessness of the situation.”

Adderall Shortage: Next Steps

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