Ziv Cohen, M.D., is a board-certified psychiatrist and clinical assistant professor of psychiatry at Weill Cornell Medicine, specializing in mood and anxiety disorders, and a forensic psychiatrist with wide experience in mental health and the law.
In a conversation with Forbes Health, Dr. Cohen discusses the ongoing Adderall shortage, first announced by the U.S. Food and Drug Administration (FDA) in October of 2022, and what it means for those affected.
What originally incited the initial shortage announcement from the FDA back in October of 2022? Why is the shortage still ongoing?
The Adderall shortage appears to be due to a number of reasons. In October 2022, the FDA announced that the shortage was due to manufacturing delays, and in particular cited Teva, a large generic pharmaceutical producer, as having “ongoing intermittent manufacturing delays.” However, others have cited the rise in prescriptions for stimulants as the primary cause of shortages. In 2020, Adderall prescriptions for adults rose by 15.1%, which was double the increase of the previous year (7.4%) .
Additional increase in demand is probably pandemic-related: children’s symptoms were more easily detected by parents, who were supervising children while they learned remotely from home, leading to more prescriptions for children as well as adults.
Another factor is the Drug Enforcement Agency (DEA), which sets quotas for the amount of active ingredients in Adderall allocated to each pharmaceutical company per year. The DEA allocates these amounts based on the previous year’s needs. When the prescriptions for stimulants increased during the COVID pandemic, the DEA’s quotas were a mismatch with the demand. Some pharmaceutical companies have petitioned the DEA for an increase in volume, and these requests have been approved in some cases.
Overall, the combination of increased demand and manufacturing interruptions have led to major disruptions in the availability of these medications for patients.
What are the FDA, pharmacies and pharmaceutical companies doing to remedy this issue?
The FDA and DEA are monitoring the need for stimulant medication and communicating with pharmaceutical companies to keep the public informed about the supply. Pharmaceutical companies are trying to increase manufacturing, but require some approvals from regulatory agencies to do so. Thus, while the government and pharmaceutical companies are trying to remediate the situation, the pace has been too slow for many patients.
Is there a certain dosage that may be harder to get right now than others?
The shortage has primarily affected immediate-release formulations of Adderall (Adderall IR). Initially, the FDA advised that extended-release Adderall (Adderall XR) was not in shortage. However, the shortage of Adderall IR has led doctors and patients to scramble for alternatives, and this has put pressure on the supply of just about all commonly used stimulants, including Adderall XR, Ritalin, Concerta and Vyvanse. All of these medications have been on intermittent backorder at pharmacies and difficult for patients to obtain.
Why is an Adderall shortage an urgent issue?
Many patients are reliant on this medication. While there are a variety of stimulants available to treat symptoms of ADHD, many patients have a better response to one particular medication. Adderall, and its extended-release formulation, Adderall XR, are very popular medications for ADHD because they are highly effective and well tolerated. When patients with ADHD don’t have medication, they will be less effective at school or at work, which may negatively impact their own life and the life of those around them, such as family or coworkers.
In addition, intimate relationships may be affected, since a distractible partner or parent places additional strain on others. In addition, when legal, safe, regulated stimulant medication is in short supply, there is concern that some patients, particularly those with addiction issues, may turn to the street for illegal forms of amphetamine.
Is this shortage a larger concern for children, especially those still enrolled in school/educational environments?
Yes, it certainly is a concern for children, who are in their prime learning years. It also creates challenges for teachers when children may be less able to regulate hyperactivity in the classroom because they do not have the medication they need. Parents may struggle doing homework with children. In addition, changing routines can be particularly disruptive for children, and therefore the experience of going on and off the ADHD medication can be challenging for children and families.
What is your advice for people who are unable to get this medication from their regular pharmacy for themselves or their children?
Most psychiatrists and other prescribers have switched their patients to Adderall alternatives, such as Ritalin, Concerta, Vyvanse and Focalin when Adderall has not been available. Although these medications are not always as effective as Adderall for a particular patient, having some form of stimulant is better than none. Patients will still feel the benefit of having their ADHD symptoms treated to some extent while they await resumption of their usual medication.
Do you recommend that those with an Adderall prescription ration their pills? Is it safe to take every other day or inconsistently?
The medication is effective on the days it is taken, even if it is not taken every day. In this way, stimulant medication is different from many other psychiatric medications, which need to be taken every day in order to be effective. However, when patients skip doses of stimulant medication, it can be quite disruptive for their routines and their functioning. One way to ration medication that many patients employ is to take the medication Monday through Friday and not on the weekend or when on vacation. Since on the weekend, children are not in school and adults are generally not working, it can be less disruptive to skip the stimulant medication on these days.
Besides alternative medications, are there any other solutions available that prescribers of Adderall could try?
Non-medication treatments for ADHD are just as important as medication therapy. They include psychotherapy geared towards addressing the symptoms of ADHD and teaching coping skills and strategies. In addition, exercise has been shown to reduce ADHD symptoms, particularly in children. If the patient is experiencing other mental health issues, which is common in ADHD, then treating those symptoms (such as anxiety and depression) will also improve focus and concentration.
This article is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health providers with any questions about a medical condition.