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  • Writer's pictureRyan Allen

Adderall shortage and key takeaways

Many have likely heard of the ongoing shortage of Adderall and other medications to treat attention-deficit/hyperactivity disorder (ADHD). Chances are, with the ever-growing prevalence of this condition in the U.S. population (now impacting over 4% of adults), you likely know someone affected by this situation. However, despite the blast radius of this urgent issue, there seems to be a good deal of confusion regarding its origins and continued progression over months. I don’t claim to have all the answers on this front, though I will certainly share what I do know and what one can potentially do about it. Perhaps even more importantly, I think there are some key points to extrapolate for everyone, not just those with ADHD and other involved chronic conditions.

So, how did this shortage start? While it actually appears to be a synergy of various factors coinciding, the most obvious to point to is that the Food and Drug Administration (FDA) and prominent pharmaceutical companies in this space admitted to numerous manufacturing delays a few months back. That said, it seems that was simply a catalyst for something greater lying beneath the surface. In fact, especially now that the logistical supply struggles seem to be pretty much resolved, many experts are suggesting that this is a rare shortage based on demand.

This leads us to the next contributor: a lagging increase in ADHD diagnoses from the COVID-19 pandemic, as reported by many doctors. Of all of the factors, this is the only one that I consider to probably be a positive change. We have seen it with countless conditions in medicine: cases increase not because the condition is more prevalent at an absolute level, but because both doctors and patients are getting better at symptom recognition and diagnosis. One of the many progressive societal reckonings that the pandemic did provide was a much greater attention to otherwise subtle aspects of our health and wellness. Of course, to people like us constantly advocating for this level of individual care and detail in the population, this is a great sign in the long term. In the short term, though, strains such as this one could be put on aspects of our healthcare system.

Nevertheless, this particular strain on production appears to have been significantly self-induced by the Drug Enforcement Administration (DEA). Because ADHD is a unique disorder, with its first-line recommended treatment being a stimulant with potential for abuse, the DEA strictly regulates the quantities of ADHD drugs that the pharmaceutical companies can produce. The problem is the DEA generates production quotas based on historical prescription data in the population, not live data. With the recent jump in diagnoses and prescriptions, there is quite a gap between the outdated DEA quotas and current population demand for these medications.

The slow adaptation of regulatory agencies to this pressing health concern for millions has become a source of frustration, and reminds me of a few of my most frequent qualms with medicine. The first is our static interpretations of fluctuating or misleading population-wide statistics. You may have seen this Instagram Reel, where we discussed the problematic conclusions from reference ranges for lab tests. In short, when you have a test done at the doctor and receive your results, you are given a reference range that tells you population averages for this test, so you can gauge what is “normal.” The problem is a decent chunk of the population is unhealthy in many regards, so an average score in the population may be far from optimal for your health. In the case of the DEA’s ADHD medication quotas, it seems clear that if they do not have the bandwidth for a centralized, live updating of prescription data and corresponding quotas, they should be using projected case data to generate their numbers. If they are using projected data and are simply far off in their calculations, one could ask why we are not investing more in studying this condition, and understanding the basis for this apparent increase in prevalence (i.e. does the cause go beyond simply an improvement in diagnosis?).

My second frustration with the DEA and others is a failure to appreciate nuance when it comes to various drugs, treatments, and conditions. A major reason cited for the creation of these quotas was the abusive potential of Adderall and other amphetamines, and a concern over doctors overprescribing as in the origins of the opioid crisis. This is of course a very important consideration to have, given the devastation opioids continue to produce in the U.S. With that said, though this topic is far too complicated to get into now, anyone who has deeply explored the opioid crisis knows that doctors’ overprescription was one of many factors (albeit a definite contributor) in the unraveling of that process. The DEA is right to address this aspect, but physician experts feel they may be exercising a level of caution that is doing more harm than good.

Figure: Drug-involved overdose deaths nationally by category of drug, over a 22-year period. The steep rise in the curve for "synthetic opioids other than Methadone (primarily fentanyl)" presents major cause for concern, and calls for all to take extra caution with sources and content when purchasing and consuming drugs. (Image: NIDA)

The harm comes from another perhaps de-prioritized lesson from the opioid epidemic. When patients cannot get their medications, they will take drastic measures if necessary. Turning to alternative sources for drugs presents the obvious danger of unreliable drug composition, as we have seen with the dramatic rise in accidental deaths due to fentanyl overdoses over the last few years. While much of this post may seem frustrating as it involves countless systemic issues, this is one critical point for any individual patient to take action in their care: know the source of your medications, and always be a healthy skeptic. Though the price tag can be upsettingly high, unfortunately brand-name drugs are often worth the investment compared to generic drugs, whose industry and regulatory processes can be a bit of a Wild West. Generic drugs can often be a good option, but if you are searching for an alternative to a brand-name drug like Adderall, it is always a good idea to have a detailed conversation with your doctor about their level of trust or concern over that medication.


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