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Shortage of Adderall and other ADHD drugs expected to last through 2024, despite federal attempts to fix it

Shortage of Adderall and other ADHD drugs expected to last through 2024, despite federal attempts to fix it

CLEVELAND, Ohio — The nationwide shortage of Adderall and related drugs, used to treat attention/deficit hyperactivity disorder, has passed the year mark with no end in sight.

High demand — from increased access to the medication via telehealth to people with long COVID-19 using ADHD drugs — makes the situation worse.

About 41.4 million Adderall prescriptions were dispensed in the United States in 2021, up more than 10% from 2020, according to IQVIA, a health research firm.

Families are scrambling to find crucial medications they rely on. Children and adults with ADHD don’t perform well in school or work when they aren’t medicated, said Dr. Max Wiznitzer, a pediatric neurologist at University Hospitals Rainbow Babies and Children’s Hospital.

ADHD is a long-term brain condition that affects a person’s ability to manage their actions, emotions and thoughts.

Some families hunt for less expensive generic versions of medication, or substitute a long-acting, once-a-day ADHD medication with one that must be taken at breakfast and lunchtime, Wiznitzer said.

“We’ve had an increasing number of children going to the school nurse at lunchtime to get a second dose of their (ADHD) medication.” Wiznitzer said. “In years past, that never happened because the children would have been on long-acting medication.”

In a domino effect, shortages have spread to several of Adderall’s generic equivalents and other stimulant ADHD medications, as patients scramble to find alternatives.

About 94% of independent pharmacy owners and managers reported shortages of Adderall or generics in a September survey released by the National Community Pharmacists Association.

Government allocations of the raw materials for making ADHD drugs were too low to meet rising demand. And drug manufacturers could be producing more of the needed medication, but aren’t.

Pharmaceutical companies, Congressional leaders and industry regulators are all looking for solutions.

Despite this, shortages may last into 2024 and beyond.

“You’re probably looking at 2025 before this levels out,” David Burke, executive director for the Ohio Pharmacist Association, a professional advocacy group.

In the meantime, many Ohio pharmacies are intentionally overstocking their supplies of these medications so they don’t run out, Burke said.

Klein’s Pharmacy in Cuyahoga Falls has had difficulty ordering all types of ADHD medications from all manufacturers, said Christina L. Cohn, assistant pharmacy manager and compounding specialist.

“The shortages seem to go in and out, and we can never be confident when we will be able to order any type of Adderall,” Cohn said. “We have had adults come to us with concerns that they are struggling to complete both work and day-to-day tasks throughout the shortage.”

More diagnoses lead to higher demand

The Adderall shortage began with Teva Pharmaceuticals, one of the nation’s top suppliers of the drug, the FDA said.

Last fall, Teva’s manufacturing delays resulted in a shortage of immediate-release Adderall.

But the pressure, from increasing numbers of people being diagnosed with the disorder and seeking medication, had been building for years.

In January 2021, there were about 7,000 Adderall prescription fills, compared to 20,000 in March 2023, according to IQVIA.

The percentage of adolescent and adult females and adult males receiving prescriptions to treat ADHD increased during from 2016 through 2022, particularly during 2020 and 2021, according to a study from the Centers for Disease Control and Prevention.

Several factors are behind the climbing number of children and adults with ADHD prescriptions.

Adderall is used to relieve brain fog in people with long COVID-19, a condition in which COVID-19 symptoms persist for months after the initial infection, Burke said.

There’s a greater recognition of ADHD in adults, resulting in more people getting on medication.

“In the years past, we have been woefully inadequate in identifying adult ADHD,” Wiznitzer said.

And as more people talk about managing their ADHD on social media, others are encouraged to explore whether they might have the same condition.

The rise of telemedicine during the pandemic made it easier to get a prescription for controlled drugs — like the stimulants used to treat ADHD — without an office visit.

In Ohio and other states, nurse practitioners and physician assistants can prescribe controlled substances.

“The more access you have to that prescription, the more prescriptions you’re going to see, because the barrier’s lessened,” Burke said.

ADHD drug companies asked to up production

Pharmaceutical quotas also contribute to the shortage of ADHD drugs.

The Drug Enforcement Administration gives companies an annual allotment of the raw materials to make stimulants, based on predictions of how many stimulant pills will be needed the following year, UH’s Wiznitzer said.

There is a year’s lag between when the allocations are set, and demand for the drug becomes apparent, Burke said.

“I’ve got X amount of (chemicals) to make Adderall with and lo and behold, by October I’m nearly out because more people are using the drugs than we anticipated,” Burke explained.

Another complicating factor is the way pills are manufactured.

After a company makes as many of a certain pill as it thinks it needs for a year, that machine is cleaned and retooled to make another pill.

This makes it difficult to suddenly ramp up production of Adderall or Ritalin when demand is unexpectedly high, Burke said. And companies don’t want a surplus because pills expire, causing waste.

“Just in the last 24 months, the (government) saw a 10% increase in the number of prescriptions. How long does that go on? Well, they made a wrong guess,” Burke said. “It’s like having a bake sale and lo and behold, more people show up and you’re out of brownies with two hours to go.”

But even though government quotas were set too low, the government also found that some manufacturers produced and sold only 70% of their allotted quota.

“There were approximately 1 billion more doses that they could have produced but did not make or ship,” the heads of the Food and Drug Administration and the Drug Enforcement Administration recently wrote in a joint letter asking ADHD drug manufacturers to increase production.

The Biden Administration also raised the production quota for Johnson & Johnson’s Concerta ADHD drug in an attempt to ease the shortfall, according to industry watchers.

But the White House cannot require pharmaceutical companies to make more of a drug or change its distribution, Burke said.

It’s unclear whether the Drug Enforcement Administration will change the quotas on stimulant production, Burke said.

“The DEA is struggling to determine what is the right amount for next year, and they don’t want to end up on the short side,” Burke said.

Since the generic version of Vyvance, a prescription medication for ADHD, received FDA approval in August 2023, the number of prescription fills for generic Vyvanse have climbed higher than for the brand name version, according to GoodRX data from GoodRX, a website that finds low prescription prices.

Patients also turned to generic Vyvance because it’s cheaper. Vyvanse costs about $469 for a 30-day supply without insurance, while the generic version is about $100 less expensive without insurance, according to GoodRX.

Demand for ADHD drugs will eventually fade, and supply will catch up with demand, Burke said. “I just think what you’re seeing now is the front end of a new curve,” he said. “I would guess that this will start to resolve itself in the next 20 to 24 months.”

Tips for coping with the shortage

Know how to get the latest information about shortages, what’s on back order and when new shipments might arrive. Find this information on the Food and Drug Administration’s drug shortage webpage, and the American Society of Health-System Pharmacists webpage.

Look for ADHD stimulant and non-stimulant alternative drugs at this complete guide to ADHD medications.

If you can’t find extended release capsules, ask for a prescription of immediate-release medication but take them twice a day.

Try brand name drugs, especially if your insurance company will allow substituting a brand name at the generic cost because they recognize that there is a shortage.

Ask your doctor to check with your pharmacy before sending an electronic prescription, to find out what the pharmacy may have as a substitute. The doctor’s office may be able to send that prescription instead.

If your local pharmacy is out of your medication, ask to have the prescription transferred to another pharmacy that does have it in stock.

Prescriptions for stimulants can’t be filled early, but ask your pharmacy to check on supplies before your prescription runs out. If the drug store doesn’t have your medication, ask the pharmacy to check with the store’s supplier.

“You just have to be creative,” Wiznitzer said.

Paying attention, following directions hard for those with ADHD

ADHD is a long-term brain condition that affects a person’s ability to manage their actions, emotions and thoughts.

Children with the disorder may be overly active and have trouble with impulsive behaviors. They may also find it difficult to pay attention, follow instructions and complete tasks.

Childhood symptoms of ADHD frequently continue into adulthood, according to the Cleveland Clinic.

Adults with the disorder may have problems remembering information, following directions, concentrating or organizing tasks.

ADHD medications work by increasing the levels of chemicals called neurotransmitters in the brain. Increasing the amount of these neurotransmitters helps improve the symptoms of ADHD.

Julie Washington covers healthcare for Read previous stories at this link.

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